Treatment guide for Microscopic Colitis

Janaina Medeiros
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@theibdeffect-blog
Treatment guide for Microscopic Colitis

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BackgroundInfliximab (IFX) is indicated for the treatment of inflammatory bowel diseases (IBD). Nevertheless, loss of response (LOR) to IFX is reported in up to 10% to 30% of patients within the first year of treatment. Our objective was to evaluate the impact of the pharmacokinetics of IFX at induction on treatment failure.MethodsThis is a longitudinal cohort study on 269 patients with IBD treated with IFX in a single center. A total of 2331 blood samples were prospectively collected from 2007 until March 2015 with a retrospective analysis of clinical data. IFX trough levels (TLs) were measured by enzyme-linked immunosorbent assay. Antibodies to IFX were measured by drug-sensitive bridging assay.ResultsDuring follow-up, patients were defined according to treatment outcome. At week 6, median IFX TL in patients requiring a switch to another treatment due to LOR (LOR switched group) (2.32 μg/mL [0.12–19.93 μg/mL]) was lower than in patients with long-term response (long-term responders) (8.66 μg/mL [0.12–12.09 μg/mL], P = 0.007) and in patients responding to optimization (LOR optimized group) (7.28 μg/mL [0.17–14.91 μg/mL], P = 0.021). At week 2, median IFX TL was lower in the LOR switched group (5.7 μg/mL [0.15–12.09 μg/mL]) compared with the long-term responders (11.92 μg/mL [0.14–19.93 μg/mL], P = 0.041) but no significant difference was reached with the LOR optimized group (11.91 μg/mL [0.23–12.09 μg/mL], P = 0.065). In the LOR switched group, median IFX TL at induction (weeks 2 and 6) was significantly lower when patients had been previously exposed to anti–tumor necrosis factor compared with naive patients (0.91 μg/mL [0.12–4.4 μg/mL] versus 6.6 μg/mL [0.15–19.93 μg/mL], P = 0.044).ConclusionsThis study suggests that patients who do not respond to any optimization strategy have lower IFX TLs during induction at week 6. IFX TLs measured early on at induction might predict treatment failure to IFX during maintenance.
Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance
….and crash 😪
Fatigue is a constant battle that we struggle to win because as soon as you try to sleep, you end up being wide awake for hours
My chronic illness brings all the doctors to the yard and they’re like “Sorry we have no idea what’s wrong or what to do.”

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Before Obamacare, insurers often labeled minor maladies pre-existing conditions. Republican health care bills could return us to those days.
Background: Rectal mesalamine is an effective induction and maintenance therapy for ulcerative colitis. Little is known about the adherence rates to rectal mesalamine or barriers to its use. The aim was to quantify the prevalence of nonadherence to rectal mesalamine and to identify patient-report...
Don’t you love it when someone says “at least it’s not cancer.

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A U.S. survey of people with Crohn’s and ulcerative colitis also found that most are initially misdiagnosed, despite repeat doctors visits.
[image description: a graphic featuring text laid over two boxes of different shades of blue.
the first box is smaller and contains two headings, “So your buddy’‘s disabled:” followed by “How Can I Help?” in quotation marks.
the second box is larger and contains a list of five subheadings and descriptions, which are as follows:
1. Pity parties are boring. I don’t need you to tell me how awful my life must be or how sorry you are that I have to deal with it. I don’t care. I’m doing exactly the same as everyone else - managing with what I’ve got.
2. Don’t assume I’m incapable. I can still open doors for myself and hold a conversation. Even with a crutch. Blind-blowing, I know. It’s frankly a little insulting how quickly people will rush to ‘help’ me when I’m using a mobility aide. If you’re not sure, then ask first! Or alternatively, wait for me to ask you.
3. Let me grab you on the stairs. Stairs fuckin’ suck and I may have to grab something very quickly in order to avoid collapsing. Sometimes that something may be you and I am always very grateful for your presence in this situation.
4. Meet in accessible spaces. If you choose to sit somewhere I can’t get to, i.e. upstairs, then I’m left with three options: a) I kick up a fuss and make you move, b) I get hurt by forcing myself to join you, or c) I sit on my own. None of these options are ideal for any of us but they could all be avoided if you’d sat somewhere else.
5. Listen to me. My condition and how I’m feeling with it changes from day to day, and what was fine yesterday might not be today. I will always try my best to communicate what I can and can’t manage; all you need to do is keep an open mind and listen to what I’m telling you.]
Not all of these points will apply to everyone with a disability, but certainly the 1st, 2nd and 5th should apply to almost everyone. I often find that nobody really knows what to do when they discover that I’m disabled, and I’m often asked “how can I help?” but never have much of an answer, so I finally thought I’d put together a masterlist for my friends to take a look at.
I just recently had a friend refuse to let me help carry groceries into my apartment because “you’re incapable” and it really hit a nerve.. yes, I need help, but if I tell you I can do something, please respect me and let me do it..
Please don’ tell me over and over again that I am doing too much. I know what my limits are and some days I feel really good I do too much and I know that I will regret it the next day. I need you to stop reminding me to slow down, I am not a child. Just let me have that good day where I feel almost normal, and please don’t tell me “I told you so” the next day, believe me I get it.

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Tofacitinib 5 and 10 mg BID were significantly more effective vs PBO as maintenance therapy over 52 wks in pts with moderately to severely active UC. Despite a dose-dependent increase in HZ, overall, AE rates were similar among both tofacitinib groups. No new safety findings emerged from those previously reported in studies of rheumatoid arthritis.
There is an association between VDZ drug levels and VDZ efficacy. These results suggest that there may be a role for therapeutic drug monitoring and drug optimization in patients receiving VDZ for CD or UC.