Program Description

The introduction of biologic therapies targeting tumor necrosis factor (TNF) has revolutionized the management of moderate to severe Crohn's disease (CD). As a result of the clinical efficacy of biologic therapies in patients with refractory CD, the clinical management of patients with moderate to severe CD is shifting from a traditional "step-up" method to an aggressive "top-down" approach with earlier use of biologics. This shift in thinking has not been fully adopted by community gastroenterologists, partly because of safety concerns associated with these agents. In addition, as the number of targeted agents grows, practical questions are arising: Which agent should be used first to minimize interaction if an alternate is needed? Should we taper therapy before switching to an alternate agent? What are the requirements for concomitant use of immunomodulators? How do we identify patients who would benefit from an aggressive top-down approach?

This program will provide physicians with clear answers to their current concerns about the efficacy and safety of anti-TNF agents, as well as strategies to address clinical questions and help them understand where newer agents will fit within their present armamentarium, improve physician competency, and eventually enhance clinical outcomes for patients with moderate to severe CD.

Faculty

	Stephen B. Hanauer, MD (Chair) Professor of Medicine and Clinical Pharmacology Director of Gastroenterology, Hepatology, and Nutrition The University of Chicago Medical Center Department of Medicine Section of Gastroenterology Chicago, IL
	Maria T. Abreu, MD Professor and Chief Division of Gastroenterology University of Miami Miller School of Medicine Miami, FL
	Bruce E. Sands, MD, MS Acting Chief, Gastrointestinal Unit Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Boston, MA

Target Audience

This program was developed for gastroenterologists who treat Crohn's disease.

Educational Objectives

Upon completion of this activity, participants should be able to:

• Discuss and compare:
  • The mechanisms of action, clinical efficacy, and safety profiles of each anti-TNF agent
  • The advantages and disadvantages of "step-up" vs. "top-down" management strategies in CD
  • The clinical significance of available and upcoming markers of disease in determining which patient is a potential candidate for top-down therapy
• Demonstrate improved ability to manage a patient with moderate to severe CD with anti-TNF therapy

System Requirements

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Accreditation

The Potomac Center for Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation Statement

The Potomac Center for Medical Education designates this educational activity for a maximum of 1.25 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Information

Potomac Center for Medical Education (PCME) adheres to the policies and guidelines, including the Standards for Commercial Support, set forth to providers by the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous.

All persons in a position to control the content of a continuing medical education program sponsored by the Potomac Center for Medical Education are required to disclose any relevant financial relationships with any commercial interest to PCME as well as to learners. All conflicts are identified and resolved by PCME in accordance with the Standards for Commercial Support in advance of delivery of the activity to learners.

The content of this activity was vetted by an external medical reviewer to assure objectivity and that the activity is free of commercial bias.

The faculty reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:

Maria T. Abreu, MD: Grant Support: Procter & Gamble; Speaker: Procter & Gamble, Salex, Prometheus, Elan

Stephen B. Hanauer, MD: Consultant: Abbott Laboratories, Bristol-Myers Squibb, Centocor, Elan, Genentech, Millennium Pharmaceuticals, UCB; Speaker: Centocor, UCB; Research: Abbott Laboratories, Bristol-Myers Squibb, Centocor, Elan, Genentech, UCB

Bruce E. Sands, MD, MS: Consultant: Cerimon, Alba Therapeutics, Biogen Idec, Abbott Laboratories, Bristol-Myers Squibb, Centocor, Elan, Otsuka, Millennium Pharmaceuticals, UCB, Procter & Gamble; Advisory Board: Cerimon, Alba Therapeutics, Abbott Laboratories, Bristol-Myers Squibb, Centocor, Elan, Otsuka, Millennium Pharmaceuticals, UCB, Procter & Gamble, Foundation for Clinical Research in IBD, Crohn's & Colitis Foundation of America; Research: Cerimon, Abbott Laboratories, Bristol-Myers Squibb, Centocor, Elan, Otsuka, Millennium Pharmaceuticals, Novartis

Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:

Laurie Frueh, MD; Carole Drexel, PhD; Donna Fucello; Blair St. Amand; Dana Simpler, MD: Nothing to Disclose

FDA Disclosure

The contents of some CME/CE activities may contain discussions of non-approved or off label uses of some agents mentioned. Please consult the prescribing information for full disclosure of approved uses.

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