General Medicine and Primary Care

Guest: Anish Patel, DO, FACG

Real-world Pattern of Biologic Use in Patients With Inflammatory Bowel Disease: Treatment Persistence, Switching, and Importance of Concurrent Immunosuppressive Therapy

Chao Chen, PhD, Abraham G Hartzema, PhD, Hong Xiao, PhD, Yu-Jung Wei, PhD, Naueen Chaudhry, MD, Ofor Ewelukwa, MD, Sarah C Glover, DO, Ellen M Zimmermann, MD

BACKGROUND AND AIMS:
Medication persistence, defined as the time from drug initiation to discontinuation of therapy, has been suggested as a proxy for real-world therapeutic benefit and safety. This study seeks to compare the persistence of biologic drugs among patients with inflammatory bowel disease (IBD).

METHODS:
Patients with newly diagnosed IBD were included in a retrospective study using Truven MarketScan database. Treatment persistence and switching was compared among biologic medications including infliximab, adalimumab, certolizumab, golimumab, and vedolizumab. Predictors for discontinuation and switching were evaluated using time-dependent proportional hazard regression.

RESULTS:
In total, 5612 patients with Crohn's disease (CD) and 3533 patients with ulcerative colitis (UC) were included in this analysis. Less than half of the patients continued using their initial biologic treatment after 1 year (48.48% in CD cohort; 44.78% in UC cohort). …

Host: Paul Doghramji, MD

Guest: Megan Arnot

Menopause is an inevitable transition in every woman’s life, but what if engaging in a basic physiological need like sex could delay its onset? Researching this potential connection is Megan Arnot, a Ph.D. candidate in the Department of Anthropology at the University College London. As the lead author of the study, she walks us through her findings and the range of factors they investigated, like the type of sexual activity and whether or not women lived with a partner.

Guest: Robin Dalal, MD

Improving the Quality of Inpatient Ulcerative Colitis Management: Promoting Evidence-Based Practice and Reducing Care Variation With an Inpatient Protocol

Sara M Lewin, MD, Ryan A McConnell, MD, Roshan Patel, MD, Suzanne R Sharpton, MD, MAS, Fernando Velayos, MD, MPH, Uma Mahadevan, MD

BACKGROUND:
Hospitalization for ulcerative colitis is a high-risk period associated with increased risk of Clostridium difficile infection, thromboembolism, and opiate use. The study aim was to develop and implement a quality-improvement intervention for inpatient ulcerative colitis management that standardizes gastroenterology consultant recommendations and improves delivery of evidence-based care.

METHODS:
All adult patients hospitalized for ulcerative colitis between July 1, 2014, and December 31, 2017, who received intravenous corticosteroids were included. On July 1, 2016, the UCSF Inpatient Ulcerative Colitis Protocol was implemented, featuring standardized core recommendations and a daily checklist for gastroenterology consultant notes, a bundled IBD electronic order set, and an opiate awareness campaign. The composite primary outcome was adherence to all 3 evidence-based care metrics: C. difficile testing performed, pharmacologic venous thromboembolism (VTE) prophylaxis ordered, and opiates avoided.

RESULTS:
Ninety-three ulcerative colitis hospitalizations occurred, including 36 preintervention and 57 postintervention. Age, gender, …

Host: Maurice Pickard, MD

Guest: Christy Harrison, MPH, RD, CDN

Fad diets are extremely popular and widely used when it comes to losing weight, yet there’s often no scientific evidence to support them. That’s why Christy Harrison, author of Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through INTUITIVE EATING, is here to dive into diet culture, fads, and intuitive eating.

Guest: Peter A. Lio, MD

Guest: Mark Boguniewicz, MD

Guest: Eric Simpson, MD, MCR

Please note: This activity is no longer available for continuing education credit.

A multidisiplinary panel is presented with a highly allergic, extremely refractory patient with atopic dermatitis. Her dermatologist wants to take the next step and start her on a biologic, but she's worried about the patient's occular history and dupilumab's conjunctivitis risk. Find out what the experts have to say about this doctor's dilemma.

Guest: Peter A. Lio, MD

Guest: Mark Boguniewicz, MD

Guest: Eric Simpson, MD, MCR

Please note: This activity is no longer available for continuing education credit.

Infants have the highest incidence of atopic dermatitis in the US but the fewest treatment options. This is a case a doctor submitted about a baby who is refractory to multiple oral and topical treatments. A multidisciplinary panel discusses how they would approach the baby's treatment, emerging options for this vulnerable patient population, and if anything can be done now to prevent progression of the atopic march later.

Guest: Peter A. Lio, MD

Guest: Mark Boguniewicz, MD

Guest: Eric Simpson, MD, MCR

Please note: This activity is no longer available for continuing education credit.

Tune in as a multidisciplinary panel discusses a clinician's question about the appropriateness of combining two biologics in a very young child with several atopic diseases.

Host: Mario R. Nacinovich, Jr., MSc

Guest: Charles P. Gerba, MD

The novel coronavirus outbreak that began in late 2019 may be the first global epidemic pronounced in the social media age, with myths and misinformation populating just as quickly and frequently as new cases. But is there any truth behind these claims? Here to shed light on this global health crisis is microbiologist Dr. Charles Gerba.

Host: Paul Doghramji, MD

Guest: Gregory S. Sawicki, MD, MPH

Even though there currently isn’t a cure for cystic fibrosis, there may finally be hope on the horizon for the more than 70,000 people around the world who are living with this debilitating disease. Joining Dr. Paul Dogramji to talk about the emerging treatment options for cystic fibrosis is Dr. Gregory Sawicki, Director at the Cystic Fibrosis Center and Assistant Professor of Pediatrics at Harvard Medical School.

Host: Mario R. Nacinovich, Jr., MSc

Guest: Paul Orchard, MD

Although it only affects about one in 18,000 people, the impacts of adrenoleukodystrophy cannot be underestimated. That’s why Dr. Paul Orchard joins Mario Nacinovich to talk about this rare—and fatal—genetic disease, why it’s often underdiagnosed and confused with other conditions, and how we can treat it once we’ve reached an accurate diagnosis.