| Release date: July 2009 Expiration date: July 31, 2010 Estimated time to complete activity: 1.25 hours |
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Co-sponsored by the University of Chicago Pritzker School of Medicine and Curatio CME Institute
Support for this activity has been provided through an independent educational grant from Procter & Gamble Pharmaceuticals.
Activity Overview
This activity highlights the optimal use of foundational therapies for ulcerative colitis (UC). The faculty discuss the clinical relevance of mucosal healing as a therapeutic end point for patients with UC and reviews strategies for modifying the risk of colorectal cancer in this population.
Target Audience
This activity has been designed to meet the educational needs of gastroenterologists involved in the care of patients with UC.
Learning Objectives
After completing this activity, participants should be able to:
- Identify factors that may differentiate optimal treatment strategies for patients with mild or moderate UC
- Discuss the dose response of various formulations of 5-aminosalicylic acid
- Review the definitions and clinical relevance of mucosal healing in UC
- Summarize the modifiable risk factors for colorectal cancer in UC
Stephen B. Hanauer, MD—Activity Chair View biography
Professor of Medicine and Clinical Pharmacology
Chief, Section of Gastroenterology, Hepatology and Nutrition
University of Chicago Pritzker School of Medicine
Chicago, Illinois
Asher A. Kornbluth, MD View biography
Clinical Professor of Medicine
The Inflammatory Bowel Disease Center
The Henry D. Janowitz Division of Gastroenterology
Mount Sinai School of Medicine
New York, New York
William J. Sandborn, MD View biography
Dorothy A. Adair Professor of Gastrointestinal Research
Vice Chair, Division of Gastroenterology and Hepatology
Mayo Clinic
Rochester, Minnesota
Accreditation Statement
The University of Chicago Pritzker School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation
The University of Chicago Pritzker School of Medicine designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Participants should not claim credit for this activity if credit was previously claimed for attending an Expert Exchange live regional symposium, on which this activity is based.
Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period July 2009 to July 31, 2010, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, (3) complete the posttest, and (4) complete the activity evaluation form, including the certificate information section.
To obtain a certificate, participants must receive a score of 70% or better on the posttest. The posttest can be accessed at the end of the activity. Please e-mail any questions to cmeinfo@curatiocme.com.
Medium
The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.
Disclosure
The University of Chicago Pritzker School of Medicine and Curatio CME Institute adhere to the ACCME Essential Areas, Standards for Commercial Support, and Policies regarding industry support of continuing medical education. Disclosure of the commercial relationships of everyone in a position to control the content of this educational activity is listed below. Speakers are also required to openly disclose discussion of any off-label, experimental, or investigational use of drugs or devices in their presentations.
Relationship information for the Activity Chair and Faculty Presenter appears below:
Stephen B. Hanauer, MD, has disclosed the following relevant financial relationships:
| Consultant: | Abbott, Bristol Myers Squibb, Centocor Ortho Biotech, Elan, Ferring, Genentech, GlaxoSmithKline, McNeil PPC, Millennium Pharmaceuticals, Novartis, Procter & Gamble Pharmaceuticals, Prometheus, Salix, Shire, UCB |
| Clinical Research: | Abbott, Bristol Myers Squibb, Centocor Ortho Biotech, Elan, Ferring, Genentech, Procter & Gamble Pharmaceuticals, Prometheus, Salix, Shire, UCB |
Asher A. Kornbluth, MD, has disclosed the following relevant financial relationships:
| Consultant / Scientific Advisor: | Centocor Ortho Biotech, Elan, Given Imaging, Procter & Gamble Pharmaceuticals, Prometheus, Salix, Shire, UCB |
| Grant / Research Support: | Abbott, Bristol Myers Squibb, Centocor Ortho Biotech, Osiris, Procter & Gamble Pharmaceuticals, Salix, UCB |
| Speaker's Bureau / Honorarium: | Abbott, Elan, Procter & Gamble Pharmaceuticals, Prometheus, Salix, Shire, UCB |
William J. Sandborn, MD, has disclosed the following relevant financial relationships:
| Consultant: | Procter & Gamble Pharmaceuticals, Salix, Shire |
| Clinical Research: | Procter & Gamble Pharmaceuticals, Shire |
Curatio CME Institute
LJ Fiedler, RN, BSN, has disclosed no relevant financial relationships.
Julie Messick, Pharm D, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, has disclosed no relevant financial relationships.
University of Chicago Center for Continuing Medical Education
The staff of the Center for Continuing Medical Education has no financial arrangements or affiliations to disclose.
Disclaimer
The information presented in this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.
Unapproved Product Use
This educational activity may contain discussion of published or investigational uses of agents that are not indicated by the US Food and Drug Administration. Curatio CME Institute, Procter & Gamble Pharmaceuticals, and the University of Chicago Pritzker School of Medicine do not recommend the use of any agent outside the labeled indications.
The opinions expressed in this educational activity are those of the faculty and do not represent the views of Curatio CME Institute, Procter & Gamble Pharmaceuticals, or the University of Chicago Pritzker School of Medicine. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
| Generic Name | Trade Name | Approved Use (if any) | Unapproved/ Investigational Use |
| Azathioprine | Imuran® | Prevention of rejection in renal homotransplantation Severe, active rheumatoid arthritis unresponsive to rest, aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs), or to agents in the class of which gold is an example |
Inflammatory bowel disease (IBD) including ulcerative colitis; chemoprevention of colorectal cancer |
| Balsalazide | Colazal® | Treatment of mildly to moderately active ulcerative colitis (UC) | Chemoprevention of colorectal cancer |
| Corticosteroids | various | UC and regional enteritis, endocrine disorders, rheumatic disorders, collagen disorders, dermatologic diseases, allergic states, ophthalmic diseases, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states, nervous system disorders (acute exacerbations of multiple sclerosis), and miscellaneous disorders (tuberculosis meningitis, trichinosis) | |
| Folic acid | various | Treatment of megaloblastic anemias due to a deficiency of folic acid | Chemoprevention of colorectal cancer |
| 3-hydroxy-3-methylglutarylcoenzyme A (HMG) CoA reductase inhibitors* | various | Primary prevention of coronary heart disease, coronary heart disease, hypercholesterolemia, adolescent patients with heterozygous familial hypercholesterolemia | Chemoprevention of colorectal cancer |
| 6-Mercaptopurine | Purinethol® | Remission induction and maintenance therapy of acute lymphatic leukemia | IBD including ulcerative colitis; chemoprevention of colorectal cancer |
| Mesalamine | Asacol® | Treatment of mildly to moderately active UC Maintenance of remission of UC |
Chemoprevention of colorectal cancer; dosages >2.4 g/d for UC |
| Mesalamine | Lialda™ | Induction of remission in patients with active, mild to moderate UC | Chemoprevention of colorectal cancer |
| Mesalamine | Pentasa® | Induction of remission and for the treatment of patients with mildly to moderately active UC | Chemoprevention of colorectal cancer |
| Mesalamine granules | Salofalk Granu-stix® | Manufactured in Germany; currently unavailable in the U.S. | |
| Olsalazine | Dipentum® | Olsalazine is indicated for the maintenance of remission of ulcerative colitis in patients who are intolerant of sulfasalazine | Chemoprevention of colorectal cancer |
| Sulfasalazine | Azulfidine® | Treatment of mild to moderate UC and as adjunctive therapy in severe UC
Prolongation of the remission period between acute attacks of UC |
Chemoprevention of colorectal cancer |
| Sulfasalazine | Azulfidine-EN® | Treatment of mild to moderate UC and as adjunctive therapy in severe UC Prolongation of the remission period between acute attacks of UC Treatment of patients with rheumatoid arthritis who have responded inadequately to salicylates or other NSAIDs Treatment of pediatric patients with polyarticular-course1 juvenile RA who have responded inadequately to salicylates or other NSAIDs |
Chemoprevention of colorectal cancer |
| Ursodiol | Actigall®, URSO®, URSO® Forte | Treatment of patients with primary biliary cirrhosis | IBD including UC; chemoprevention of colorectal cancer |
Abbreviations List
| 4-ABA | 4-aminobenzoic acid |
| 5-ASA | 5-aminosalicylic acid |
| 6-MP | 6-mercaptopurine |
| AI | activity index |
| AZA | azathioprine |
| CI | confidence interval |
| CRC | colorectal cancer |
| DAI | disease activity index |
| D-CRC | dysplasia and colorectal cancer |
| ESR | erythrocyte sedimentation rate |
| FU | follow-up |
| HR | hazard ratio |
| IBD | inflammatory bowel disease |
| IND | indefinite dysplasia |
| MTWSI | Modified Truelove and Witts Severity Index |
| MTX | methotrexate |
| NSAID | nonsteroidal anti-inflammatory drug |
| OR | odds ratio |
| PGA | Physician Global Assessment |
| PSC | primary sclerosing cholangitis |
| SCCAI | Simple Clinical Colitis Activity Index |
| SD | standard deviation |
| UC | ulcerative colitis |
| UCCS | Ulcerative Colitis Clinical Score |
| UCDAI | Ulcerative Colitis Disease Activity Index |
| UDCA | ursodeoxycholic acid |
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