Activity Details

Free CME
1.25 AMA PRA Category 1 Credits
Released: August 31, 2018
Expires: August 31, 2019
1.25 hours to complete

Accredited By

This continuing medical education activity is provided by Vindico Medical Education

Target Audience

The intended audience for this activity is gastroenterologists and other health care professionals involved in the treatment of patients with Crohn's disease.

Learning Objectives

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

  • Evaluate the mechanisms behind primary and secondary non-response to biologic agents in the treatment of Crohn’s disease.
  • Utilize strategies that mitigate the loss of response to a biologic agent in Crohn’s disease.
  • Incorporate new guidelines and best practices regarding the use of therapeutic drug monitoring in the management of Crohn’s disease.
  • Apply new evidence regarding the safety and efficacy of biologic agents used in the long-term management of Crohn’s disease.

Activity Description

Despite the proven therapeutic efficacy of anti-tumor necrosis factor (TNF) agents, treatment failures due to primary nonresponse or secondary loss of response (LOR) can occur in patients with Crohn’s disease. Approximately 10% to 20% of patients with inflammatory bowel disease have been reported to be unresponsive to induction treatment with anti-TNF agents. A significant portion of those patients who initially respond to anti-TNF treatment lose response over time, with an annual increased risk of 13% to 24%. Several distinct mechanisms for secondary LOR have been suggested, including the formation of antidrug antibodies. In clinical practice, therapeutic drug monitoring (TDM) has been shown to be clinically useful, cost-effective, and associated with improved clinical and endoscopic outcomes. The use of TDM in patients with Crohn’s disease provides a personalized approach to optimize treatment, with new guidelines for its use now available. In addition, the measurement of drug concentrations and antidrug antibodies can be used to improve treatment outcomes. This case-based activity is intended to help clinicians integrate scientific advances into real-world practice settings, assess the causes of LOR, incorporate new guidelines into practice, and effectively utilize TDM for patients receiving biologic agents.


  • Decisions, Decisions…Primary and Secondary Loss of Response to Biologics in Crohn’s Disease
  • Therapeutic Drug Monitoring in the Management of Crohn’s Disease
  • Case Presentation – Loss of Response, TDM, and Dose Optimization


Bruce E. Sands, MD, MS (Activity Chair)
Chief, Dr. Henry D. Janowitz Division of Gastroenterology 
Dr. Burrill B. Crohn Professor of Medicine 
Icahn School of Medicine at Mount Sinai Hospital and Mount Sinai Health System 
New York, NY

Consulting Fee: AbbVie, Allergan, Amgen, Arena Pharmaceuticals, Boehringer-Ingelheim, Capella Bioscience, Celgene, EnGene, Ferring, Gilead, Janssen, Lilly, Lyndra, MedImmune, Oppilan, Otsuka, Palatin Technologies, Pfizer, Rheos Medicines, Seres Therapeutics, Takeda, Target PharmaSolutions, Theravance, TiGenix, Vivelix
Contracted Research: Celgene, Takeda

Edward V. Loftus Jr., MD
Professor of Medicine 
Consultant, Division of Gastroenterology and Chair, Inflammatory Bowel Disease Interest Group 
Mayo Clinic 
Rochester, MN

Consulting Fee: AbbVie, Amgen, Celgene, Celltrion Healthcare, Eli Lilly, Janssen, Napo Pharma, Pfizer, Takeda, UCB
Contracted Research: AbbVie, Allergan, Amgen, Celgene, Genentech, Gilead, Janssen, Pfizer, MedImmune, Receptos, Robarts Clinical Trials, Seres Therapeutics, Takeda, UCB

Marla Dubinsky, MD
Chief, Pediatric Gastroenterology and Hepatology
Co-Director, the Susan and Leonard Feinstein IBD Clinical Center
Icahn School of Medicine at Mount Sinai
New York, NY

Consulting Fee: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Genentech, Janssen, Pfizer, Prometheus, Salix, Shire, Takeda, UCB

Ronald A. Codario, MD, EMBA, FACP, FNLA, RPVI, CHCP
No relevant financial relationships to disclose.

Vindico Medical Education Staff:
Disclosure: No relevant financial relationships to disclose. 

Signed Disclosures are on file at Vindico Medical Education, Office of Medical Affairs and Compliance.

Conflict of Interest Policy/Disclosure Statement

In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the past 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control.  Relationship information appears above.

Accreditation Statement

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

Designation of Credit

Vindico Medical Education designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Receiving Credit

To participate in this CME activity, you must read the objectives, answer the pretest questions, read the articles, and complete the posttest and evaluation. Provide only one (1) correct answer for each question. A satisfactory score is defined as answering 3 out of 4 of the posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, Vindico Medical Education will issue an AMA PRA Category 1 Credit(s)™ Certificate.

Statement of Commercial Support

This activity is supported by an educational grant from UCB, Inc.

Disclaimer Statement/Disclosure of Unlabeled Use

The material presented at or in any Vindico Medical Education continuing education activity does not necessarily reflect the views and opinions of Vindico Medical Education. Neither Vindico Medical Education nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the FDA. All readers and continuing education participants should verify all information before treating patients or utilizing any product.

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