Podcasts about Infliximab

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Best podcasts about Infliximab

Latest podcast episodes about Infliximab

The Future of Dermatology
Episode 76 - HS Management Insights from SF Derm Society 2024 Annual Meeting | The Future of Dermatology Podcast

The Future of Dermatology

Play Episode Listen Later Mar 4, 2025 12:42


Summary In this episode of the Future of Dermatology podcast, we revisit the SF Derm 2024 Annual meeting and hear from Dr. Haley Naik, MD, as she discusses the management of Hidradenitis Suppurativa (HS). Dr. Naik covers the importance of controlling inflammation with medical therapies, the role of biologics in treatment, and the clinical pearls for using TNF inhibitors effectively. She emphasizes the need for early intervention to prevent permanent disfigurement and the importance of optimizing medical management before considering surgical options. Takeaways Using medical therapies to control inflammation is crucial. When to start a biologic is a common question. Preventing permanent disfigurement is a key goal. Adalimumab was the first FDA approved drug for HS. Real world goals include reducing pain and symptoms. Complete response means no pain and no new lesions. Infliximab is the best biologic for moderate to severe HS. Layering therapies is important for effective management. Optimizing medical management is essential before surgery. Chapters 00:00 - Introduction to the Future of Dermatology Podcast 01:03 - Managing Hidradenitis Suppurativa (HS) with Medical Therapies 04:35 - Understanding Biologics in HS Treatment 09:17 - Clinical Pearls for TNF Inhibitors in HS 11:35 - Optimizing HS Management Before Surgery

Podcast Viszeralmedizin
Ileozökalresektion vs. Infliximab: Langzeitdaten aus der LIR!C-Studie zum Morbus Crohn

Podcast Viszeralmedizin

Play Episode Listen Later Feb 21, 2025 28:13


In dieser Folge spreche ich mit Prof. Kersting aus Greifswald über die Langzeitdaten der LIR!C-Studie, die die laparoskopische Ileozökalresektion mit der medikamentösen Therapie durch Infliximab bei Crohn-Patienten vergleicht. Gemeinsam diskutieren wir, welche Vorteile diese Ansätze bieten, wie sie hinsichtlich der langfristigen Therapieeffizienz abschneiden und welche Rolle die Studie in der zukünftigen Behandlung von Crohn-Patienten spielen könnte. Viel Freund beim Hören Moderation: PD Dr. med. Christoph Paasch Gast: Prof. Dr. med. Kersting (Greifswald) und Prof. Zeissig (Greifswald) Besprochene Publikation: Stevens TW, Haasnoot ML, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: retrospective long-term follow-up of the LIR!C trial. Lancet Gastroenterol Hepatol. 2020;5:900–07. doi: 10.1016/S2468-1253(20)30117-5. Unter folgendem Link können bei der Landesärztekammer Brandenburg 2 Fortbildungspunkte erworben werden. Der Kursinhalt umfasst stets 3 Folgen: https://lernportal.laekb.de/goto.php?target=crs_3487&client_id=laekb.

The Rounds Table
Episode 104 - Treatment of Severe Behçet's Syndrome

The Rounds Table

Play Episode Listen Later Feb 6, 2025 7:41


Welcome back Rounds Table Listeners!We are back today with a solo episode with Dr. John Fralick!This week, he will discuss a paper exploring infliximab versus cyclophosphamide for the treatment of severe Behçet's Syndrome. Here we go!Infliximab versus Cyclophosphamide for Severe Behçet's Syndrome (0:00 – 5:15).And for the Good Stuff:Bob Ross and Painting (5:15 – 6:28).Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePodsDo you ever feel like you can't get ahead of charting? Freed AI has an AI driven scribe for you! You can try Freed for free right now by going to getfreed.ai. Listeners can use the INTERN50 code for $50 off their first month!

Real Life Pharmacology - Pharmacology Education for Health Care Professionals

On this top 200 drugs podcast, we are covering medications 141-145. Raltegravir, ustekinumab, meloxicam, infliximab, and Nighttime Cold and Flu are the medications that are covered on this episode. Raltegravir is an integrase inhibitor that is used to manage HIV infection and may also be used for post-exposure prophylaxis. Ustekinumab is a monoclonal antibody that can help reduce inflammation by binding interleukins. Meloxicam is an NSAID used for pain and anti-inflammatory purposes. GI bleeding risk is a top adverse effect to monitor for. Infliximab is a monoclonal antibody that can be used for autoimmune disorders such as psoriatic arthritis, rheumatoid arthritis, ulcerative colitis, and Crohn's disease. Nighttime Cold and Flu medication is a combination product that often includes acetaminophen, dextromethorphan, and doxylamine.

The EMJ Podcast: Insights For Healthcare Professionals
Episode 232: Redefining IBD: From Patient to Pioneer

The EMJ Podcast: Insights For Healthcare Professionals

Play Episode Listen Later Dec 12, 2024 53:23


In this episode, Jonathan sits down with Philip Smith to discuss groundbreaking advancements in gastroenterology, the impact of IBD research, and how his personal journey with Crohn's disease has influenced his career. From international guidelines to the role of digital platforms in healthcare, Smith offers a compelling insight into the future of gastrointestinal medicine.   Timestamps: (00:00)-Introduction (02:35)-Specialising in luminal gastroenterology (05:30)-IBD patient to practitioner (11:20)-Career highs and lows (17:40)-Smith's impactful IBD research (21:02)-The international approach to gastroenterology (25:39)-Screening colonoscopy (29:49)-Advancements and future priorities for IBD care (37:37)- Leveraging social media to engage with the gastroenterology community (43:30)-Identifying high-impact studies as EiC (49:06)-Three wishes for healthcare

Evidence-Based GI: An ACG Publication and Podcast
Subcutaneous Infliximab for Maintenance of IBD Remission: Added Convenience with Potential for Improved Efficacy?

Evidence-Based GI: An ACG Publication and Podcast

Play Episode Listen Later Nov 20, 2024 19:04


The Immunobuddies
Episode 116: Gastro Toxicities with Professor Nick Powell - Role of topical steroids, Infliximab

The Immunobuddies

Play Episode Listen Later Nov 15, 2024 42:54


Reumatología On Demand
Recomendaciones para el manejo de arteritis de células gigantes y de Takayasu Parte 1

Reumatología On Demand

Play Episode Listen Later Nov 13, 2024 7:30


(Actualidad Médica 30) Buen día, hoy otro podcast de Actualidad Médica.   Hoy vamos a explorar dos enfermedades reumatológicas complejas que afectan los vasos sanguíneos: la arteritis de células gigantes (ACG) y la arteritis de Takayasu (AT). Estas enfermedades, aunque poco comunes, pueden tener un impacto significativo en la vida de quienes las padecen.ENLACE: https://bit.ly/actualidadmédica30Te invitamos a que participes en la sección de comentarios.¿Qué quieres escuchar? ¿Cuáles son tus temas de interés?Síguenos en www.reumatimes.com, donde podrás encontrar cubrimientos de congresos de reumatología y resúmenes de actualidad en la especialidad. Encuéntranos en YouTube como ReumaTimes Y Facebook como Reumatologia.Online o ReumaTimes, en Instagram como dr.sebastianherrera o ReumaTimes, y en X (antes Twitter) como @Reuma_Online_ o @ReumaTimes. Estamos también en TikTok como @Reuma_Times.Síguenos en www.reumatimes.comTambién puedes encontrarnos en: Twitter: https://twitter.com/Reuma_Online_ Facebook: https://www.facebook.com/reumatologiaonline/ Instagram: https://www.instagram.com/dr.sebastianherrera/ Spreaker: https://www.spreaker.com/user/11390404 Spotify: https://spoti.fi/3DILwLP

In conversation with...
Peter De Cruz on the PREDICT-UC trial of intensified versus standard dose infliximab for steroid-refractory acute severe ulcerative colitis

In conversation with...

Play Episode Listen Later Nov 6, 2024 14:42


Peter De Cruz (University of Melbourne) discusses the PREDICT-UC trial of intensified versus standard dose infliximab induction therapy for steroid-refractory acute severe ulcerative colitis.Read the full article:https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00200-0?dgcid=buzzsprout_icw_podcast_generic_langasContinue this conversation on social!Follow us today at...https://twitter.com/thelancethttps://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

Zalma on Insurance
Zalma's Insurance Fraud Letter - February 15, 2024

Zalma on Insurance

Play Episode Listen Later Feb 15, 2024 11:57


ZIFL Volume 28, Issue 4 The Source for the Insurance Fraud Professional Subscribe here: Zalma's Insurance Fraud Letter (ZIFL) continues its 28th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma.  It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ The current issue can be read in full at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-02-15-2024.pdf and includes the following articles: Do the Crime, Serve the Time Chutzpah: After Pleading Guilty Fraudster Tried to Reduce his Sentence by an Appeal After pleading guilty, Armando Valdes appealed his 60-month sentence for health care fraud, in violation of 18 U.S.C. § 1347. Valdes's conviction and sentence arose out of his scheme to submit millions of dollars in fraudulent medical claims to United Healthcare and Blue Cross Blue Shield for intravenous infusions of Infliximab, an expensive immunosuppressive drug. These infusions, purportedly given to patients at Valdes's medical clinic, Gasiel Medical Services (“Gasiel”), were either not provided or were medically unnecessary. Read the full article in Adobe pdf format at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-02-15-2024.pdf More McClenny Moseley & Associates Issues This is ZIFL's twenty fourth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. Read the full article in Adobe pdf format at http://zalma.com/blog/wp- California Insurance Commissioner Lara Issues Consumer Fraud Alert As Flood Recovery Begins In San Diego County Following the recent flooding in San Diego which damaged and destroyed hundreds of homes, businesses, and vehicles, Insurance Commissioner Ricardo Lara put the Department of Insurance on alert for potential fraud and illegal actions targeting flood victims. Read the full article in Adobe pdf format at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-02-15-2024.pdf Health Insurance Fraud Convictions Guilty in Arkansas Shaona Mizell, 52, of Paragould, Arkansas. in Pulaski County Circuit Court on January 23, Mizell pleaded guilty to Medicaid Fraud, a class A misdemeanor. Read the full article in Adobe pdf format at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-02-15-2024.pdf Arson and Restitution CONVICTED ARSONIST MUST PAY RESTITUTION A fire at a residential property destroyed several structures and made nearly all of the owner's personal property unsalvageable. Insurance Fraud Attempt Defeated THE HAWAIIAN, ATTEMPTED FRAUD DEFEATED BY A THOROUGH INVESTIGATION The following is a fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. Read the full article in Adobe pdf format at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-02-15-2024.pdf Barry Zalma Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com  https://www.newsbreak.com/@c/1653419?s=01 Go to X @bzalma; Read the full article in Adobe pdf format at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-02-15-2024.pdf --- Support this podcast: https://podcasters.spotify.com/pod/show/barry-zalma/support

Zalma on Insurance
Go to Jail, Do Not Pass Go

Zalma on Insurance

Play Episode Listen Later Dec 27, 2023 8:19


Fraudster Must Serve Time and Lose His Residence to Pay Restitution Post 4698 Armando Valdes appealed his 60-month sentence for health care fraud after he pleaded guilty. Valdes's conviction and sentence arose out of his scheme to submit millions of dollars in fraudulent medical claims to United Healthcare and Blue Cross Blue Shield for intravenous infusions of Infliximab, an expensive immunosuppressive drug. These infusions, purportedly given to patients at Valdes's medical clinic, Gasiel Medical Services ("Gasiel"), were either not provided or were medically unnecessary. In United States Of America v. Armando Valdes, No. 22-12837, United States Court of Appeals, Eleventh Circuit (December 19, 2023) the Eleventh Circuit disposed of the arguments asserted by Valdes. LOSS AMOUNT Federal Courts sentence convicted defendants based upon offense levels set by federal statutes. The sentences are increased with the amount of "loss" caused by the offense. In Valdes's case, his base offense level was increased by 22 levels because the district court found that the loss amount was $38 million, and thus more than $25 million. Section 2B1.1(b)(1)(L) provides that a defendant's base offense level is increased by 22 levels if the loss from the fraud offense was more than $25 million but less than $65 million.  Intended loss includes harm "that would have been impossible or unlikely to occur." ANALYSIS Valdes did not show the Eleventh Circuit that the district court's loss amount of $38 million was clearly erroroneous. Valdes admitted that through Gasiel, he submitted approximately $33 million in fraudulent claims to United Healthcare and approximately $5 million in fraudulent claims to Blue Cross Blue Shield. Even if United Healthcare was unlikely to reimburse Valdes for the entire amount billed or for duplicate claims those claims were nonetheless properly included in the intended loss amount. At the sentencing hearing, Valdes's own fraud analyst testified that, even accounting for duplicate claims, the total loss amount was above $25 million, the threshold for the 22-level increase in Valdes's offense level. Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library. --- Support this podcast: https://podcasters.spotify.com/pod/show/barry-zalma/support

Empowered Patient Podcast
Using Anti-TNF Therapy and Synthetic Cannabinoids for Pain and Inflammation with Dr. Jim Woody 180 Life Sciences

Empowered Patient Podcast

Play Episode Listen Later Nov 29, 2023 19:14


Dr. Jim Woody, CEO and Director of 180 Life Sciences, discusses the company's vision for safer pain and inflammation management. Their earlier work on anti-TNF therapy revolutionized the treatment of conditions such as rheumatoid arthritis. Now 180 Life Sciences focuses on additional indications of inflammation, fibrosis, and cognitive dementia for using anti-TNFs. Jim highlights their research on the anti-inflammatory and analgesic properties of cannabinoids and the potential of synthetic cannabinoid analogs for pain management and appetite suppression. Jim elaborates, "Many years ago, I was Chief Scientific Officer at a company called Centocore, and they were one of the first companies developing therapeutic monoclonal antibodies. One of them that we developed was called anti-TNF. It was Infliximab, which was the FDA name that it received. In your body, circulating around, there are hundreds of small proteins. Those that modify the immune system are called cytokines, and most of them are good actors. One of the bad actors is what they call tumor necrosis factor. It was given that name because of some mouse studies in cancer that were done, although they turned out to be incorrect." "My colleagues in the UK, Dr. Marc Feldmann and Dr. Ravinder Maini had data suggesting that rheumatoid arthritis inflammation and pain were driven by TNF. We were the first to treat ten patients with anti-TNF in this program, in the whole world. Now, anti-TNF is the therapy of choice for rheumatoid arthritis, which, of course, is severe inflammation of the joints." "We also found out that TNF was driving these inflammations in Crohn's disease, Psoriasis, and in Ulcerative Colitis. We discovered all of those from Centocore, and now anti-TNF is the largest-selling class of biologics, at almost $40 billion a year. The current favorite is Humira from AbbVie, but J&J, who bought Centocore, still makes a billion dollars a year from Infliximab sales or its brand name Remicade." #180LifeSciences #LifeSciences #CBD #Biotech #Fibrosis #AntiTNF #DupuytrensDisease #PainManagement #Inflammation  180lifesciences.com Download the transcript here

Empowered Patient Podcast
Using Anti-TNF Therapy and Synthetic Cannabinoids for Pain and Inflammation with Dr. Jim Woody 180 Life Sciences TRANSCRIPT

Empowered Patient Podcast

Play Episode Listen Later Nov 29, 2023


Dr. Jim Woody, CEO and Director of 180 Life Sciences, discusses the company's vision for safer pain and inflammation management. Their earlier work on anti-TNF therapy revolutionized the treatment of conditions such as rheumatoid arthritis. Now 180 Life Sciences focuses on additional indications of inflammation, fibrosis, and cognitive dementia for using anti-TNFs. Jim highlights their research on the anti-inflammatory and analgesic properties of cannabinoids and the potential of synthetic cannabinoid analogs for pain management and appetite suppression. Jim elaborates, "Many years ago, I was Chief Scientific Officer at a company called Centocore, and they were one of the first companies developing therapeutic monoclonal antibodies. One of them that we developed was called anti-TNF. It was Infliximab, which was the FDA name that it received. In your body, circulating around, there are hundreds of small proteins. Those that modify the immune system are called cytokines, and most of them are good actors. One of the bad actors is what they call tumor necrosis factor. It was given that name because of some mouse studies in cancer that were done, although they turned out to be incorrect." "My colleagues in the UK, Dr. Marc Feldmann and Dr. Ravinder Maini had data suggesting that rheumatoid arthritis inflammation and pain were driven by TNF. We were the first to treat ten patients with anti-TNF in this program, in the whole world. Now, anti-TNF is the therapy of choice for rheumatoid arthritis, which, of course, is severe inflammation of the joints." "We also found out that TNF was driving these inflammations in Crohn's disease, Psoriasis, and in Ulcerative Colitis. We discovered all of those from Centocore, and now anti-TNF is the largest-selling class of biologics, at almost $40 billion a year. The current favorite is Humira from AbbVie, but J&J, who bought Centocore, still makes a billion dollars a year from Infliximab sales or its brand name Remicade." #180LifeSciences #LifeSciences #CBD #Biotech #Fibrosis #AntiTNF #DupuytrensDisease #PainManagement #Inflammation  180lifesciences.com Listen to the podcast here

Gettin Deep
Ep 25 - "I F***** Love Chemo" - Murray Clark

Gettin Deep

Play Episode Listen Later Nov 29, 2023 215:40


PGX for Pharmacists
From PharmD to Pharmacogenomics Test Developer: Dr. Thierry Dervieux's Story of Revolutionizing Healthcare Through Precision Medicine for Immune Modulated Inflammatory Diseases | PGx For Pharmacists

PGX for Pharmacists

Play Episode Listen Later Nov 20, 2023 28:46


Becky Winslow, BS, PharmD Host and Pharmacogenomics Medical Science Liaison; Behnaz Sarrami, MS, PharmD, Host and Pharmacogenomics Medical Science Liaison; Thierry Dervieux, PharmD, PhD, Chief Scientific Officer at Prometheus Laboratories Disclaimer: Behnaz Disclaimer: These are my personal views and opinions, and I am not speaking on behalf of Castle Biosciences, Inc. Becky Disclaimer: These are my personal views and opinions, and I am not speaking on behalf of any other entity.   Transcription:  1 00:00:06,190 --> 00:00:19,620 You're listening to the Pharmacy podcast Network in a world where one size fits all medications dominate the pharmaceutical industry. 2 00:00:20,079 --> 00:00:24,750 Precision medicine brings a ray of hope for those seeking customized health care. 3 00:00:25,350 --> 00:00:32,830 Pharmacists have a unique opportunity to help people in need of specialized testing to ensure medications work as intended. 4 00:00:33,540 --> 00:00:44,680 Welcome to PGX for pharmacists where we unravel the wonders of precision medicine and its potential to revolutionize the way we approach pharmacy care. 5 00:00:45,169 --> 00:00:52,790 Get ready to uncover the secrets behind pharmacogenomics and how it's transforming lives one genome at a time. 6 00:00:52,799 --> 00:00:53,189 Hello, 7 00:00:53,200 --> 00:00:53,950 everyone. 8 00:00:54,159 --> 00:00:55,080 I'm your host, 9 00:00:55,090 --> 00:00:56,389 Doctor Becky Winslow. 10 00:00:56,409 --> 00:01:09,860 And you're listening to the PGX for Pharmacist podcast that we magazine recognized in 2021 as the ninth most listened to genetics podcasts in the world on the PGX for Pharmacist podcast. 11 00:01:09,870 --> 00:01:16,690 We explore all things pharmacogenomics related and our mission is to educate and advocate for PGX. 12 00:01:16,769 --> 00:01:23,849 We accomplish this mission through exclusive interviews with highly qualified and well experienced pharmacogenomics. 13 00:01:23,860 --> 00:01:29,720 Industry leaders such as today's special guest and my name is Baas Sami, 14 00:01:29,730 --> 00:01:32,739 the co-host of PGX for Pharms podcast, 15 00:01:32,750 --> 00:01:33,860 Pharmacogenomics, 16 00:01:33,870 --> 00:01:36,819 medical science liaison and a mentor to pharmacist. 17 00:01:36,889 --> 00:01:40,239 Connect with us on linkedin and let's get a conversation going. 18 00:01:40,269 --> 00:01:46,720 We want to hear from you and how you're impacting pharmacogenomic stakeholders and what you have learned throughout your journey. 19 00:01:48,510 --> 00:01:49,010 Ok. 20 00:01:49,019 --> 00:01:50,819 So without any further ado, 21 00:01:50,839 --> 00:01:54,769 I'm extremely pleased to introduce to our audience. 22 00:01:54,919 --> 00:01:56,059 Doctor Theory Devo, 23 00:01:57,239 --> 00:02:01,129 the Chief Scientific Officer at Prometheus Laboratories, 24 00:02:01,139 --> 00:02:08,139 and Perme Prometheus Laboratories is a reference clinical laboratory that's focused on the diagnosis, 25 00:02:08,149 --> 00:02:13,330 prognosis and monitoring of immune mediated inflammatory diseases. 26 00:02:13,970 --> 00:02:14,229 So, 27 00:02:14,240 --> 00:02:14,649 thank you, 28 00:02:14,660 --> 00:02:17,759 Doctor De for joining us on the podcast. 29 00:02:17,770 --> 00:02:18,589 Today. 30 00:02:18,600 --> 00:02:23,190 I'm excited to share your and Prometheus's story with our audience. 31 00:02:23,649 --> 00:02:25,630 Um in particular, 32 00:02:25,639 --> 00:02:45,369 I'm excited about you sharing your career journey as a farm D phd and Chief scientific officer and designer of the Predictor PK AD A which is a precision guided dosing test for the optimization of Humira Remicade and their bio cylinders. 33 00:02:46,119 --> 00:02:46,449 So, 34 00:02:46,460 --> 00:03:04,220 one of Bana's and my main goals for this episode of the PGX for Pharmacist podcast is to expand our audience's notion of what a PGX test looks like and to inspire them to think bigger than the traditional box PGX test. 35 00:03:04,229 --> 00:03:08,020 Most of them or most of you are uh familiar with. 36 00:03:09,020 --> 00:03:09,429 So, 37 00:03:09,440 --> 00:03:22,179 Doctor D uh I'd like to start the podcast by having our guests um introduce themselves and elaborate on how you are a pharmacogenomics expert. 38 00:03:23,619 --> 00:03:23,800 Yeah, 39 00:03:23,809 --> 00:03:24,250 thank you, 40 00:03:24,259 --> 00:03:25,759 Becky for having me. 41 00:03:25,770 --> 00:03:26,850 Uh uh Yes. 42 00:03:26,860 --> 00:03:27,289 So I am a, 43 00:03:27,300 --> 00:03:30,820 I am a pharmacist uh with uh a family who is a, 44 00:03:30,830 --> 00:03:33,039 a doctorate in pharmacokinetics. 45 00:03:33,539 --> 00:03:44,520 Uh I completed my studies in France and I came as a postdoc uh fellow uh to work in the United States about 20 years ago to work on the pharmacogenomic of anti cancer agents, 46 00:03:44,929 --> 00:03:49,160 uh primarily uh six Maturin as well as methotrexate. 47 00:03:49,169 --> 00:03:50,550 After my post doc, 48 00:03:50,770 --> 00:03:52,960 uh I moved uh in industry for promet. 49 00:03:53,490 --> 00:04:01,429 So I have a large experience in uh uh the implementation of pharmacogenetics testing in immune mediated inflammatory disease. 50 00:04:01,509 --> 00:04:12,550 Our lab Rome was the first uh clinical laboratory in the United States to offer the fin uh metyl transfer genotyping as well as the thin metabolites. 51 00:04:12,559 --> 00:04:13,029 So, 52 00:04:13,050 --> 00:04:21,989 uh uh of uh of 70 publications in the field and uh I'm very uh very excited to have uh to be on the postcard with you uh uh today. 53 00:04:23,660 --> 00:04:24,220 All right. 54 00:04:24,230 --> 00:04:27,359 So thank you for qualifying yourself as an expert. 55 00:04:27,369 --> 00:04:27,619 So, 56 00:04:27,630 --> 00:04:32,839 let's jump right in and delve into your current PGX work. 57 00:04:32,850 --> 00:04:33,279 So, 58 00:04:33,489 --> 00:04:36,540 if you'll tell us um a little about Prometheus, 59 00:04:36,549 --> 00:04:38,000 specifically, 60 00:04:38,010 --> 00:04:40,350 what is Prometheus's mission? 61 00:04:40,359 --> 00:04:43,799 And how are you guys going about accomplishing your mission? 62 00:04:44,760 --> 00:04:44,980 Yeah, 63 00:04:44,989 --> 00:04:45,700 sure. 64 00:04:45,709 --> 00:04:47,459 Uh So Promet is a, 65 00:04:47,470 --> 00:04:52,790 is a reference uh clinical laboratory based in Southern California in San Diego. 66 00:04:53,230 --> 00:04:56,809 Uh The company has been there for uh over 25 years. 67 00:04:56,820 --> 00:05:03,950 We are uh specialize in the differential diagnosis of autoimmune G I disease uh disorders, 68 00:05:04,059 --> 00:05:06,019 uh gastrointestinal disorder, 69 00:05:06,230 --> 00:05:08,619 uh and inflammatory bowel disease. 70 00:05:08,980 --> 00:05:10,299 And over the years, 71 00:05:10,309 --> 00:05:16,600 we have developed a portfolio of a differentiated solution to facilitate the diagnosis, 72 00:05:16,609 --> 00:05:17,470 the prognosis, 73 00:05:17,480 --> 00:05:18,429 the monitoring, 74 00:05:18,660 --> 00:05:21,910 as well as therapy selection with pharmacogenetics testing, 75 00:05:21,920 --> 00:05:24,730 which we are offering to our clinical laboratory. 76 00:05:24,829 --> 00:05:26,350 And most importantly, 77 00:05:26,410 --> 00:05:27,299 uh recently, 78 00:05:27,309 --> 00:05:35,660 we are uh uh developing some uh uh testing solution with the credit topic care test to optimize treatment to uh biologics. 79 00:05:36,470 --> 00:05:37,130 Ok. 80 00:05:37,140 --> 00:05:37,329 Well, 81 00:05:37,339 --> 00:05:37,450 that, 82 00:05:37,459 --> 00:05:38,049 that's great. 83 00:05:38,059 --> 00:05:46,100 Can you also tell us uh about the Prois Library of Precision Medicine Tests for inflammatory bowel disease for patients? 84 00:05:46,109 --> 00:05:49,230 how they benefit medication therapy management. 85 00:05:49,239 --> 00:05:56,429 Stakeholders across the IB DS patients journey from diagnosis to treatment to disease, 86 00:05:56,440 --> 00:06:02,049 monitoring through remission and how they differ from other lab tests for IBD and his treatments. 87 00:06:02,709 --> 00:06:03,209 Yes. 88 00:06:03,220 --> 00:06:03,369 So, 89 00:06:03,380 --> 00:06:04,399 so we uh our, 90 00:06:04,410 --> 00:06:10,100 our clinical laboratory offers some uh highly specialized test to facilitate the, 91 00:06:10,109 --> 00:06:16,779 the diagnostic of uh to facilitate the differential diagnosis of uh uh inflammatory bowel disease. 92 00:06:16,790 --> 00:06:22,359 So we are following uh testing solution with uh serological testing, 93 00:06:22,529 --> 00:06:23,799 for example, 94 00:06:23,809 --> 00:06:38,410 uh uh piana as as as well as uh macro microbial uh uh antibodies that are present uh uh in Crohn's disease as well as uh over uh auto uh auto antibodies that are present in er colitis. 95 00:06:39,339 --> 00:06:43,684 These are conditions that are uh uh somewhat difficult to treat. 96 00:06:43,704 --> 00:06:49,994 Uh And uh we are uh uh offering those tests to uh help uh gastroenterologist. 97 00:06:50,015 --> 00:06:51,114 Uh uh first of all, 98 00:06:51,125 --> 00:07:03,434 to establish a differential diagnosis of IBD as compared to other uh condition typically uh uh irritable bowel syndrome as well as over gastrointestinal disorder. 99 00:07:03,445 --> 00:07:05,635 When the diagnostic is established, 100 00:07:05,910 --> 00:07:31,839 uh we offer uh testing to uh establish a prognosis where we're gonna in inform the clinician that the patient has a more aggressive uh disease that will require more aggressive treatment where uh we can uh provide the testing solution to initiate uh uh the most appropriate therapy for uh for the patient uh with uh a testing where we are uh basically uh you know, 101 00:07:31,850 --> 00:07:36,559 establish de determining some genotyping with the fit transferal genotyping. 102 00:07:36,570 --> 00:07:37,279 For example, 103 00:07:37,290 --> 00:07:40,250 where we can uh indicate that the patient is, 104 00:07:40,260 --> 00:07:45,079 is likely uh to present with a side effect to those medication. 105 00:07:45,399 --> 00:07:46,170 And once you know, 106 00:07:46,179 --> 00:07:47,799 the the treatment is initiative, 107 00:07:47,809 --> 00:08:16,089 we have a portfolio of solution uh to facilitate the monitoring of the disease of the inflammatory bowel disease as well as the dosing optimization with uh uh the answer test which uh measure blood level uh for uh uh monoclonal antibodies that are indicated in the treatment of IB start with starting with Infliximab Adalimumab as well as uh Tein and vidal. 108 00:08:16,980 --> 00:08:24,040 So we have a comprehensive portfolio to uh to surround the clinician with uh a variety of testing solution. 109 00:08:24,049 --> 00:08:30,250 With our goal being to improve the uh the outcome uh of patients with uh with diabetes. 110 00:08:30,260 --> 00:08:34,520 And I think that the pharmacist has a very important role to play from that perspective. 111 00:08:35,179 --> 00:08:36,039 So theory, 112 00:08:36,049 --> 00:08:40,239 could you elaborate for us more on the predictor test? 113 00:08:40,249 --> 00:08:42,758 Um especially since you designed that test, 114 00:08:42,768 --> 00:08:44,218 we'd really like to know, 115 00:08:44,489 --> 00:08:45,039 um you know, 116 00:08:45,049 --> 00:08:49,638 what did that take and what role does it play in your suite of testing? 117 00:08:51,049 --> 00:08:51,270 Yeah. 118 00:08:51,280 --> 00:08:51,890 Sure. 119 00:08:51,900 --> 00:08:52,510 So the, 120 00:08:52,520 --> 00:08:52,570 the, 121 00:08:52,580 --> 00:08:52,989 the, 122 00:08:53,000 --> 00:08:53,229 the, 123 00:08:53,239 --> 00:08:59,960 the predictor test is uh uh is uh is utilized when the patient is receiving treatment. 124 00:09:00,280 --> 00:09:18,190 It's been speci specifically designed to optimize uh biological uh uh disease modifiers such as Infliximab adalimumab that are co therapies in the treatment of inflammatory bowel disease as well as other immune uh mediated inflammatory. 125 00:09:18,200 --> 00:09:21,549 This is what the test does is to you connect the blood specimen, 126 00:09:22,229 --> 00:09:23,049 uh you know, 127 00:09:23,059 --> 00:09:24,750 with dosing information. 128 00:09:25,039 --> 00:09:41,989 And what we do is to uh uh provide guidance uh to clinician with uh respect of the best dose to give in order to achieve the best the level which is the most consistent with uh uh the disease control that needs to be achieved for the patient. 129 00:09:42,169 --> 00:09:43,729 Typically a vast majority, 130 00:09:43,739 --> 00:09:46,159 about two third of a third to two third, 131 00:09:46,169 --> 00:09:54,669 a third of patient uh tend to be uh uh unresponsive uh to this uh very expensive medication. 132 00:09:54,989 --> 00:09:57,960 Uh Not because they don't have the uh you know, 133 00:09:57,969 --> 00:09:59,289 typically because they have a, 134 00:09:59,299 --> 00:09:59,590 you know, 135 00:09:59,599 --> 00:10:05,599 pharmacokinetic uh suboptimal pharmacokinetic uh that makes them uh you know, 136 00:10:05,609 --> 00:10:09,440 unresponsive because uh not enough drug has been given. 137 00:10:09,450 --> 00:10:18,469 So what we do with a predictor test is to basically estimate the pa the pharmacokinetic uh parameter for the patient. 138 00:10:18,750 --> 00:10:24,729 And from then uh re report the best dose uh to give in order to achieve the, 139 00:10:24,760 --> 00:10:31,570 the level which is consistent with the uh the most uh uh effective disease control to be achieved for the patient. 140 00:10:32,169 --> 00:10:33,059 So we are offering, 141 00:10:33,070 --> 00:10:38,049 we have developed a test for the Infliximab as well as Adalimumab which is Humira, 142 00:10:38,909 --> 00:10:41,309 but these are antimony causes factor. 143 00:10:41,460 --> 00:10:49,549 And we are also developing the test for vidur as well as uh is that are widely used also in the treatment of, 144 00:10:49,559 --> 00:10:51,969 of uh inflammatory bubble disease. 145 00:10:51,979 --> 00:10:52,669 Wow, 146 00:10:52,679 --> 00:10:55,450 uh for MET is a suite of tests. 147 00:10:55,460 --> 00:11:00,940 Goes well beyond um the PGX testing that our audience is most familiar with, 148 00:11:01,299 --> 00:11:08,679 uh which typically only includes snips for cyp genes and some pharmacodynamic genes. 149 00:11:08,690 --> 00:11:31,424 This is really exciting um genes and biomarkers related to immunology are not commonly found in what I call the box PGX tests such as those uh made by large uh laboratory manufacturing companies um where the panel has a set number of genes and uh you know, 150 00:11:31,434 --> 00:11:36,054 it was developed by a larger laboratory for maybe smaller laboratories use. 151 00:11:36,729 --> 00:11:39,010 So my understanding, 152 00:11:39,020 --> 00:11:53,729 having talked with you extensively theory is that immunology has fewer PGX test available because it's actually more difficult say than oncology to research and develop tests. 153 00:11:53,739 --> 00:11:54,119 So, 154 00:11:54,130 --> 00:12:00,729 could you elaborate for our audience on the difficulties that are associated with immunology, 155 00:12:00,739 --> 00:12:05,830 research and developing tests uh for immunology versus say oncology? 156 00:12:06,330 --> 00:12:06,530 Yeah, 157 00:12:06,539 --> 00:12:07,049 sure. 158 00:12:07,059 --> 00:12:09,969 So in uh in immunology, 159 00:12:09,979 --> 00:12:11,590 as compared to oncology, 160 00:12:11,599 --> 00:12:17,169 there is no such a thing such as a somatic mutation where for example, 161 00:12:17,179 --> 00:12:18,429 you're gonna have a behalf, 162 00:12:18,440 --> 00:12:18,659 you know, 163 00:12:18,669 --> 00:12:20,349 that indicates that the patient, 164 00:12:20,679 --> 00:12:20,919 you know, 165 00:12:20,929 --> 00:12:25,239 is likely to benefit or not from some treatment in immunology. 166 00:12:25,250 --> 00:12:26,750 This is far more complicated, 167 00:12:26,760 --> 00:12:28,830 complicated for the reason, 168 00:12:29,239 --> 00:12:31,020 starting with uh the fact that, 169 00:12:31,030 --> 00:12:31,179 you know, 170 00:12:31,190 --> 00:12:36,219 the response to this uh medication uh are multifactorial. 171 00:12:36,260 --> 00:12:37,820 And the fact that uh you know, 172 00:12:37,830 --> 00:12:39,380 the mutation that uh the, 173 00:12:39,390 --> 00:12:39,619 the, 174 00:12:39,630 --> 00:12:45,190 the single nucleotide polymorphism in the GM line which uh uh you know, 175 00:12:45,200 --> 00:12:52,429 can potentially associate with uh with outcome uh uh uh uh a lo in advance, 176 00:12:52,440 --> 00:12:58,359 meaning that uh they're gonna have a weak association uh with a response to those medications. 177 00:12:58,369 --> 00:13:09,609 So there is a necessity in immunology to combine multiple genetic polymorphism together in order to achieve uh some uh performances characteristics that will make uh you know, 178 00:13:09,619 --> 00:13:09,859 the, 179 00:13:09,869 --> 00:13:10,380 the, 180 00:13:10,390 --> 00:13:10,520 the, 181 00:13:10,530 --> 00:13:13,219 the clinician uh you know, 182 00:13:13,419 --> 00:13:15,619 uh order the test and most importantly, 183 00:13:15,630 --> 00:13:15,840 the, 184 00:13:15,849 --> 00:13:16,179 the, 185 00:13:16,190 --> 00:13:17,739 the payer to pay for the test. 186 00:13:17,750 --> 00:13:20,469 So this field has been uh you know, 187 00:13:20,479 --> 00:13:20,679 is, 188 00:13:20,690 --> 00:13:21,705 is moving for, 189 00:13:21,715 --> 00:13:21,994 you know, 190 00:13:22,005 --> 00:13:24,575 there are some tests that are being developed right now. 191 00:13:24,924 --> 00:13:39,034 But the biggest challenge is to be able to achieve again the the threshold of uh of performance that makes the test is variable enough uh to be uh again ordered by the clinician and the utilize uh to the benefit of the patient. 192 00:13:39,659 --> 00:13:41,200 I couldn't agree with you more. 193 00:13:41,210 --> 00:13:53,489 Um I've worked on the payer side or market access side of pharmacogenomics and even uh with a box test for which there's um a lot of research data available, 194 00:13:53,500 --> 00:13:55,119 even with those, 195 00:13:55,130 --> 00:13:59,760 it's sometimes difficult uh to get payers um to see the value. 196 00:13:59,770 --> 00:14:01,640 So I absolutely agree with you. 197 00:14:01,940 --> 00:14:03,679 Um The fact that you guys are, 198 00:14:03,690 --> 00:14:11,789 are uh investing in producing the data necessary says a lot about your laboratory. 199 00:14:11,979 --> 00:14:12,559 Um you know, 200 00:14:12,570 --> 00:14:15,380 and how committed you are to this testing and, 201 00:14:15,390 --> 00:14:17,320 and how you believe in the testing. 202 00:14:18,039 --> 00:14:23,640 So I just want to make sure that our audience recognizes that, 203 00:14:24,359 --> 00:14:24,619 you know, 204 00:14:24,630 --> 00:14:31,820 Prometheus doesn't simply provide tests to determine if drugs for IBD will be effective and safe. 205 00:14:32,190 --> 00:14:36,900 Um And maybe what the dose of the drug should be for the patient, 206 00:14:36,909 --> 00:14:40,219 but you have that whole suite of tests. 207 00:14:40,229 --> 00:14:47,380 Um the diagnostic test for the differential diagnosis all the way through remission. 208 00:14:48,030 --> 00:14:53,390 So can you elaborate you elaborated on it some in the previous question? 209 00:14:53,400 --> 00:15:01,229 But um can you tell us the difference between how you had to actually develop the test? 210 00:15:01,520 --> 00:15:02,530 Um You didn't, 211 00:15:02,539 --> 00:15:03,059 in other words, 212 00:15:03,070 --> 00:15:10,659 purchase a test from another manufacturer with the biomarkers that you include in your testing. 213 00:15:10,669 --> 00:15:16,830 Can you elaborate on how much more difficult it is to to develop a test from scratch? 214 00:15:18,169 --> 00:15:18,320 Yeah, 215 00:15:18,330 --> 00:15:18,659 sure. 216 00:15:18,669 --> 00:15:18,809 I mean, 217 00:15:18,820 --> 00:15:22,070 this is this is challenging for multiple and first of all, 218 00:15:22,080 --> 00:15:23,130 you need to have the, 219 00:15:23,419 --> 00:15:27,450 you need to have a clinical data set available with specimen available. 220 00:15:27,460 --> 00:15:28,159 Uh you know, 221 00:15:28,169 --> 00:15:28,780 in front, 222 00:15:28,859 --> 00:15:29,770 obviously, 223 00:15:29,859 --> 00:15:30,890 available. 224 00:15:31,200 --> 00:15:35,890 Uh So we are leveraging a pro meters a large bi bank of specimen. 225 00:15:36,299 --> 00:15:37,190 Uh as I said, 226 00:15:37,200 --> 00:15:39,719 Prometheus has been founded 25 years ago. 227 00:15:39,729 --> 00:15:40,599 So over the, 228 00:15:40,760 --> 00:15:41,919 the past two decades, 229 00:15:41,929 --> 00:15:54,849 we have been able to assemble a large uh substrate of data and specimen which we are uh uh using to uh uh establish our proof of concept if you will. 230 00:15:54,859 --> 00:16:07,559 And then when we have uh identify some genetic polymorphism that are uh adequately uh associated with uh uh disease outcome and disease progression as well as uh toxicity. 231 00:16:07,969 --> 00:16:11,469 Then we are entering validation phase where we are uh you know, 232 00:16:11,570 --> 00:16:14,789 using validation cohorts where we are again, 233 00:16:14,969 --> 00:16:22,630 combining multiple modalities together uh patient demographic as well as genetic marker together with theological marker. 234 00:16:22,640 --> 00:16:23,190 Actually, 235 00:16:23,500 --> 00:16:27,419 to come up with some Multivariate models that are uh again, 236 00:16:27,429 --> 00:16:39,250 bringing the performances characteristics of the pharmacogenomic test or its combination with our marker to the level where it's supposed to be in the first place to meet uh uh payer. 237 00:16:39,650 --> 00:16:41,190 And uh obviously, 238 00:16:41,200 --> 00:16:41,760 again, 239 00:16:41,770 --> 00:16:45,320 the patient uh to the benefit of the patient and to, 240 00:16:45,330 --> 00:16:46,619 to improve its outcome, 241 00:16:46,739 --> 00:16:47,429 the outcome. 242 00:16:48,340 --> 00:16:53,380 I think what you're describing really is the future of pharmacogenomics. 243 00:16:53,390 --> 00:16:54,599 Um In other words, 244 00:16:54,609 --> 00:17:03,419 not singing out pharmacogenomics as you know the end all and be all in the treatment paradigm. 245 00:17:03,559 --> 00:17:08,040 But using a PGX test in combination with, 246 00:17:08,050 --> 00:17:09,069 like you mentioned, 247 00:17:09,250 --> 00:17:11,160 other serological tests, 248 00:17:11,170 --> 00:17:12,959 maybe other genetic tests. 249 00:17:13,290 --> 00:17:14,890 Um But you know, 250 00:17:14,900 --> 00:17:25,869 I think what we want our audience to really wrap their heads around is that PGX is just a piece of that larger puzzle um from diagnosis to treatment to, 251 00:17:25,880 --> 00:17:26,910 to remission. 252 00:17:27,239 --> 00:17:29,880 So I think you guys are absolutely, 253 00:17:29,890 --> 00:17:31,579 you're already in the future. 254 00:17:31,589 --> 00:17:32,849 In other words, 255 00:17:32,859 --> 00:17:33,130 you know, 256 00:17:33,140 --> 00:17:39,689 you're already providing all these different uh tests um like you mentioned to, 257 00:17:39,699 --> 00:17:44,310 to facilitate from diagnosis to remission to remission. 258 00:17:44,660 --> 00:17:45,520 That's correct. 259 00:17:45,530 --> 00:17:45,829 Yeah. 260 00:17:46,349 --> 00:17:55,089 So um you've given us so much great information about uh the tests that that you guys offer. 261 00:17:55,329 --> 00:18:02,060 Can you explain to our audience um your newest test? 262 00:18:02,069 --> 00:18:03,859 Uh the responder test. 263 00:18:04,150 --> 00:18:12,979 And um what role it will play in the paradigm from the diagnosis of IBD to remission? 264 00:18:14,050 --> 00:18:14,260 Yeah, 265 00:18:14,270 --> 00:18:14,760 sure. 266 00:18:14,770 --> 00:18:15,569 So we, 267 00:18:15,579 --> 00:18:18,069 we are doing things a little bit different than other. 268 00:18:18,079 --> 00:18:19,489 We do believe that uh you know, 269 00:18:19,500 --> 00:18:21,449 the it has to be simple. 270 00:18:21,459 --> 00:18:24,189 Uh uh We can obviously construct some very, 271 00:18:24,199 --> 00:18:33,530 very complex algorithm and there are some tests that do that with a very sophisticated machine learning based tools that are available using neural networks, 272 00:18:33,540 --> 00:18:33,729 you know, 273 00:18:33,739 --> 00:18:34,790 those sorts of things. 274 00:18:34,800 --> 00:18:39,729 But we have taken on a different approach where with the responder test, 275 00:18:39,739 --> 00:18:40,329 we are basically, 276 00:18:40,339 --> 00:18:45,160 we are taking an approach which is very simple to address the first and foremost. 277 00:18:45,170 --> 00:18:53,020 Most important aspect of responding uh predicting response to uh to medication is the pharmacokinetics. 278 00:18:53,280 --> 00:19:03,250 Uh You cannot be responding to a drug if the drug is not given and you obviously cannot respond to a drug if the drug is not metabolized adequately. 279 00:19:03,359 --> 00:19:06,349 And this is what we are doing with the responder test. 280 00:19:06,579 --> 00:19:09,010 We are addressing some uh uh you know, 281 00:19:09,020 --> 00:19:11,630 fundamental issues with those uh biologist, 282 00:19:11,640 --> 00:19:12,410 for example, 283 00:19:12,660 --> 00:19:15,170 uh the anti tumor necrosis factors. 284 00:19:15,180 --> 00:19:15,650 So, 285 00:19:15,750 --> 00:19:19,199 such as uh Infliximab and Adalimumab, 286 00:19:19,209 --> 00:19:23,050 it is well known uh that uh uh those drugs, 287 00:19:23,060 --> 00:19:25,689 first of all are prone to immunization. 288 00:19:25,989 --> 00:19:36,949 Uh Meaning that uh uh the drug itself uh is recognized by the immune system uh and digested by the antigen presenting cells. 289 00:19:36,959 --> 00:19:42,209 If you will uh where you gonna have uh uh an immune uh uh response, 290 00:19:42,380 --> 00:19:56,979 uh mounted a cancer drug to produce uh immunogen that will severely impact its pharmacokinetics where the labels will be inadequate to produce uh the desired uh anti-inflammatory effects. 291 00:19:56,989 --> 00:19:57,150 So, 292 00:19:57,160 --> 00:19:58,890 we are with the risk conductors, 293 00:19:58,900 --> 00:20:01,040 we are combining two things together. 294 00:20:01,189 --> 00:20:07,959 First of all is the genetic test itself which uh predicts the risk of immun immunization. 295 00:20:07,969 --> 00:20:18,010 The name of the test is on HL A uh DQ A 105 ali uh that uh uh promotes the presentation of the, 296 00:20:18,020 --> 00:20:19,130 of the, 297 00:20:19,140 --> 00:20:19,910 of Infliximab, 298 00:20:20,010 --> 00:20:20,750 for example, 299 00:20:20,760 --> 00:20:32,130 to the T cell repertoire in order to uh promote the Ronon expansion and the formation of the anti antibodies together with uh another dimension which is the clearance, 300 00:20:32,140 --> 00:20:33,670 which is as important. 301 00:20:33,949 --> 00:20:36,209 Uh One of the key issue is the, 302 00:20:36,219 --> 00:20:36,770 the, 303 00:20:36,780 --> 00:20:41,239 the monoclonal antibodies and uh such as Infliximab or Adalimumab. 304 00:20:41,329 --> 00:20:42,280 But in fact, 305 00:20:42,290 --> 00:20:45,890 a neon antibodies that those drugs are uh you know, 306 00:20:45,900 --> 00:20:49,010 cleared and consumed uh from the, 307 00:20:49,020 --> 00:20:50,949 from the central compartment if you will, 308 00:20:50,959 --> 00:20:54,520 since we are doing a little bit of uh uh pharmacokinetics here. 309 00:20:54,530 --> 00:20:56,020 And uh uh you know, 310 00:20:56,030 --> 00:21:06,670 if the patient present who is uh a high degree of inflammatory burden is gonna have uh the patient will have a high clearance and that's gonna worsen uh in the, 311 00:21:06,680 --> 00:21:13,939 in the presence again of the HL AD Q A 105 genetic marker that uh associate with uh immunization. 312 00:21:13,949 --> 00:21:16,859 So I but this is a combination of both, 313 00:21:17,199 --> 00:21:19,359 these are the predictive factors of pharmacokinetic, 314 00:21:20,359 --> 00:21:38,209 which we combine together where the patient presenting with a risk of immunization as well as accelerated clearance due to the fact that the patient has high inflammation or due to the fact that they are so intrinsic pharmacokinetic properties that makes that the patient, 315 00:21:38,219 --> 00:21:38,300 you know, 316 00:21:38,310 --> 00:21:39,479 will clear the drug very, 317 00:21:39,489 --> 00:21:40,260 very fast. 318 00:21:40,560 --> 00:21:41,670 For example, 319 00:21:41,680 --> 00:21:46,819 due to the inefficient uh recirculation of the drug itself with the new, 320 00:21:46,869 --> 00:21:46,930 the, 321 00:21:46,939 --> 00:21:50,599 the the in the reticular on the system. 322 00:21:50,920 --> 00:21:51,619 Together, 323 00:21:51,630 --> 00:22:02,109 those patients presenting with uh uh together these uh poor prognostic factor of pharmacokinetic origin will tend to be severely underdose, 324 00:22:02,380 --> 00:22:06,719 will not be responding to the drug uh adequately as and they, 325 00:22:06,729 --> 00:22:10,719 and they probably should in the first place if you are able to address uh you know, 326 00:22:10,729 --> 00:22:12,270 the the the exposure. 327 00:22:12,439 --> 00:22:14,079 So what we do with this test, 328 00:22:14,089 --> 00:22:21,640 we will be able to inform uh the clinic that the patient is at risk of achieving, 329 00:22:21,650 --> 00:22:30,829 of achieving suboptimal pharmacokinetics and therefore being able to adjust the dose uh uh to start with more adequately. 330 00:22:30,839 --> 00:22:38,650 So that the the the proper uh exposure is achieved uh during induction to again to, 331 00:22:38,660 --> 00:22:39,040 to, 332 00:22:39,050 --> 00:22:39,380 to, 333 00:22:39,390 --> 00:22:40,890 to achieve a better outcome. 334 00:22:41,040 --> 00:22:47,270 And I think the pharmacist will have a very important role to play here in terms of absolutely, 335 00:22:47,280 --> 00:22:51,239 that information is priceless in the management of these medications. 336 00:22:51,250 --> 00:22:54,930 So thanks for elaborating on that. 337 00:22:56,010 --> 00:22:59,040 And if I may add in our previous conversation, 338 00:22:59,050 --> 00:23:00,810 uh before the recording of podcast, 339 00:23:00,819 --> 00:23:08,869 we had discussed um you guys' robust platform for collaborating with payers to obtain market access and reimbursements for the test. 340 00:23:09,109 --> 00:23:14,109 But without stealing the Thunder from uh Prometheus market access and reimbursement team, 341 00:23:14,199 --> 00:23:22,619 can you please uh briefly detail how Prometheus has proactively worked with payers to solve the problem. 342 00:23:22,920 --> 00:23:27,349 Um the population health problem by building the evidence payers want, 343 00:23:27,359 --> 00:23:41,170 want to see um about your test before you go to the market and then build the test and then hope the payers will see the value and the result and then that will improve the market access and reimbursement for your um precision medicine test. 344 00:23:42,160 --> 00:23:42,339 Yeah. 345 00:23:42,349 --> 00:23:43,180 So briefly I can, 346 00:23:43,189 --> 00:23:43,579 I'm, 347 00:23:43,589 --> 00:23:46,619 I'm probably not the right person to answer that question. 348 00:23:46,630 --> 00:23:47,369 We have a very, 349 00:23:47,380 --> 00:23:52,400 very efficient market access group uh uh pro meters that does a splendid job. 350 00:23:52,410 --> 00:23:59,780 But uh uh uh what I can tell you that we have an evidence uh uh development plan in place where we, 351 00:23:59,790 --> 00:24:14,000 we are establishing the clinical utility of our testing solution by demonstrating uh the payer value uh with respect of uh patient management and uh uh and the, 352 00:24:14,010 --> 00:24:16,630 and the impact of our technology on the, 353 00:24:16,640 --> 00:24:18,119 on physician behavior. 354 00:24:18,430 --> 00:24:21,319 Uh We have uh uh already uh you know, 355 00:24:21,329 --> 00:24:25,160 commercialized uh two of those tests for which we have initiated, 356 00:24:25,170 --> 00:24:29,040 initiated the Power studies uh that uh uh you know, 357 00:24:29,050 --> 00:24:32,000 already provide uh you know, 358 00:24:32,104 --> 00:24:34,484 differentiated and the value to, 359 00:24:34,494 --> 00:24:35,915 to the payer where we are, 360 00:24:35,925 --> 00:24:36,025 the, 361 00:24:36,035 --> 00:24:46,005 the clinicians are basically using our technology to make treatment decision uh as well as uh some prospective clinicality study which we are initiating, 362 00:24:46,145 --> 00:24:47,555 initiating to. 363 00:24:47,564 --> 00:24:48,574 Um uh again, 364 00:24:48,584 --> 00:24:49,425 demonstrate the, 365 00:24:49,435 --> 00:24:49,915 the, 366 00:24:49,925 --> 00:24:50,244 the, 367 00:24:50,255 --> 00:24:53,594 the payer value you uh uh we can certainly follow up with, 368 00:24:53,604 --> 00:24:58,755 uh you can certainly follow up with our market access group uh uh as appropriate there. 369 00:24:58,765 --> 00:25:00,765 Uh They can fill you with more information. 370 00:25:01,349 --> 00:25:01,589 No, 371 00:25:01,599 --> 00:25:02,520 that totally makes sense. 372 00:25:02,530 --> 00:25:03,310 That totally makes sense. 373 00:25:03,319 --> 00:25:10,890 But um we're excited that you're also farm d So how did you get to this role of outside the box path? 374 00:25:10,900 --> 00:25:11,550 There? 375 00:25:11,640 --> 00:25:17,530 There may be a pharmacist student or pharmacist wanting to switch or transition into a role such as yours, 376 00:25:17,540 --> 00:25:19,609 which is a Chief Scientific Officer. 377 00:25:19,619 --> 00:25:20,609 I want to learn more. 378 00:25:20,619 --> 00:25:23,920 So how would you um can you talk a little bit about that? 379 00:25:24,560 --> 00:25:24,780 Well, 380 00:25:24,790 --> 00:25:26,270 we are clinical laboratories. 381 00:25:26,280 --> 00:25:29,400 So in order to uh uh to be in my role, 382 00:25:29,410 --> 00:25:34,020 you need to have uh uh you need to have expertise in clinical laboratory science. 383 00:25:34,030 --> 00:25:36,140 So for the students is basically, 384 00:25:36,150 --> 00:25:36,300 you know, 385 00:25:36,310 --> 00:25:40,770 to do the family degree and then complete the family degree with uh a doctorate, 386 00:25:40,780 --> 00:25:40,930 you know, 387 00:25:40,939 --> 00:25:44,260 which is uh focus on clinical laboratory science. 388 00:25:44,270 --> 00:25:46,079 So you can achieve uh uh you know, 389 00:25:46,089 --> 00:25:47,640 the all the elements you need to be, 390 00:25:47,650 --> 00:25:48,219 for example, 391 00:25:48,229 --> 00:25:53,189 board certified uh as uh as as medical laboratory director. 392 00:25:53,199 --> 00:25:55,160 So you can uh uh so, 393 00:25:55,170 --> 00:25:55,589 uh yeah, 394 00:25:55,599 --> 00:25:56,030 this is, 395 00:25:56,040 --> 00:25:56,400 this is, 396 00:25:56,410 --> 00:25:57,209 this is uh you know, 397 00:25:57,219 --> 00:25:59,160 a great opportunity I think for pharmacies, 398 00:25:59,170 --> 00:26:10,800 there is an absolute need to uh have the clinical pharmacist provide uh uh drug information to healthcare professional as well as uh assist patient with the monitoring of their disease, 399 00:26:10,810 --> 00:26:15,229 the effectiveness of the therapy and um and uh you know, 400 00:26:15,239 --> 00:26:16,060 monitoring the, 401 00:26:16,069 --> 00:26:20,969 the side effect and the toxicity from uh from those uh those medication. 402 00:26:24,650 --> 00:26:24,959 Well, 403 00:26:24,969 --> 00:26:32,119 the I know our audience is going to have uh additional questions for you. 404 00:26:32,130 --> 00:26:32,540 I mean, 405 00:26:32,989 --> 00:26:35,609 you've provided them with so much great information, 406 00:26:35,619 --> 00:26:44,959 but it's only the beginning of what they could possibly learn um about um the testing that you do for IBD and, 407 00:26:44,969 --> 00:26:46,729 and even your career path. 408 00:26:47,050 --> 00:26:47,530 So, 409 00:26:47,540 --> 00:26:49,300 if you wouldn't mind telling us, 410 00:26:49,310 --> 00:26:51,359 um because we have to wrap up, 411 00:26:51,369 --> 00:26:52,670 unfortunately, 412 00:26:53,150 --> 00:26:55,810 this episode of the podcast, 413 00:26:55,819 --> 00:27:00,250 uh could you tell us how our audience members might be able to contact you directly. 414 00:27:01,260 --> 00:27:01,449 Yeah, 415 00:27:01,459 --> 00:27:07,079 I can be contacted on my uh on my email at TT W at como slab dot com. 416 00:27:07,949 --> 00:27:08,810 All right. 417 00:27:09,069 --> 00:27:09,300 Well, 418 00:27:09,310 --> 00:27:14,290 thank you again so much uh for joining us on this episode. 419 00:27:14,300 --> 00:27:15,290 We really, 420 00:27:15,300 --> 00:27:29,530 really hope that our listeners um ideas of not only what PGX can be but how PGX can be utilized in a comprehensive testing suite. 421 00:27:29,709 --> 00:27:35,670 We really hope that our a our audience will um listen in and learn this information. 422 00:27:36,280 --> 00:27:37,869 Um And to our audience, 423 00:27:37,880 --> 00:27:39,439 thank you for tuning in. 424 00:27:39,449 --> 00:27:42,619 We really hope that you've learned from this episode. 425 00:27:43,130 --> 00:27:46,339 Uh We do a whole lot of PG Xing here on this podcast. 426 00:27:46,349 --> 00:27:48,380 We talk about PGX Science, 427 00:27:48,390 --> 00:27:52,030 clinical application and the business of PGX. 428 00:27:52,260 --> 00:27:54,880 So we'd love to hear about from you. 429 00:27:55,099 --> 00:27:56,479 I love to hear from you. 430 00:27:56,489 --> 00:27:58,439 Um What can we teach you? 431 00:27:58,449 --> 00:28:00,920 What more can we teach you through our podcast? 432 00:28:00,930 --> 00:28:12,349 So please drop us a message on linkedin and let us know and please share this link to this podcast link episode with everyone so they can tune in and listen to the PGX for promises podcast. 433 00:28:12,520 --> 00:28:15,369 Leave us a review on Apple podcast or Spotify. 434 00:28:15,459 --> 00:28:18,130 And you can also visit us on PGX four, 435 00:28:18,140 --> 00:28:22,989 the number four Rx dot com to listen to all our other episodes. 436 00:28:23,000 --> 00:28:23,079 Well, 437 00:28:23,089 --> 00:28:23,790 thank you. 438 00:28:24,199 --> 00:28:28,750 Thanks for your interest in PGX and for spending some time with us. 439 00:28:28,760 --> 00:28:35,670 Please share this podcast and leave us a review on Apple podcasts or Spotify for all of our episodes. 440 00:28:35,680 --> 00:28:39,390 Please visit PGX for Rx dot com. 441 00:28:39,569 --> 00:28:43,380 That's PGX for Rx dot com.  

PVRoundup Podcast
American Cancer Society updates lung cancer screening guidelines

PVRoundup Podcast

Play Episode Listen Later Nov 7, 2023 3:37


Pharmacy Podcast Network
From PharmD to Pharmacogenomics Test Developer: Dr. Thierry Dervieux's Story of Revolutionizing Healthcare Through Precision Medicine for Immune Modulated Inflammatory Diseases | PGx For Pharmacists

Pharmacy Podcast Network

Play Episode Listen Later Oct 27, 2023 28:46 Transcription Available


Becky Winslow, BS, PharmD Host and Pharmacogenomics Medical Science Liaison; Behnaz Sarrami, MS, PharmD, Host and Pharmacogenomics Medical Science Liaison; Thierry Dervieux, PharmD, PhD, Chief Scientific Officer at Prometheus Laboratories In this episode of the PGX for Pharmacists Podcast, Dr. Thierry Dervieux, Dr. Behnaz Sarrami, and I discuss Dr. Dervieux's career as a PharmD, PhD, and chief scientific officer who has designed a pharmacogenomics test prescribers may use to optimize biosimilars for autoimmune gastrointestinal diseases. Dr. Dervieux will illustrate to our audience pharmacogenomics' potential beyond Tier 1 and 2 genetic testing by describing the clinical validity and utility of his laboratory's suite of tests in the autoimmune gastrointestinal disease diagnosis and treatment market. Behnaz and I hope this episode will inspire pharmacists interested in pharmacogenomics to think beyond the boxed PGx test most laboratories offer when they think about PGx and consider all the biological systems in which genetics impacts drugs' efficacy and safety. Disclaimer: Behnaz Disclaimer: These are my personal views and opinions, and I am not speaking on behalf of Castle Biosciences, Inc. Becky Disclaimer: These are my personal views and opinions, and I am not speaking on behalf of any other entity.   Transcription: 1 00:00:06,190 --> 00:00:19,620 You're listening to the Pharmacy podcast Network in a world where one size fits all medications dominate the pharmaceutical industry. 2 00:00:20,079 --> 00:00:24,750 Precision medicine brings a ray of hope for those seeking customized health care. 3 00:00:25,350 --> 00:00:32,830 Pharmacists have a unique opportunity to help people in need of specialized testing to ensure medications work as intended. 4 00:00:33,540 --> 00:00:44,680 Welcome to PGX for pharmacists where we unravel the wonders of precision medicine and its potential to revolutionize the way we approach pharmacy care. 5 00:00:45,169 --> 00:00:52,790 Get ready to uncover the secrets behind pharmacogenomics and how it's transforming lives one genome at a time. 6 00:00:52,799 --> 00:00:53,189 Hello, 7 00:00:53,200 --> 00:00:53,950 everyone. 8 00:00:54,159 --> 00:00:55,080 I'm your host, 9 00:00:55,090 --> 00:00:56,389 Doctor Becky Winslow. 10 00:00:56,409 --> 00:01:09,860 And you're listening to the PGX for Pharmacist podcast that we magazine recognized in 2021 as the ninth most listened to genetics podcasts in the world on the PGX for Pharmacist podcast. 11 00:01:09,870 --> 00:01:16,690 We explore all things pharmacogenomics related and our mission is to educate and advocate for PGX. 12 00:01:16,769 --> 00:01:23,849 We accomplish this mission through exclusive interviews with highly qualified and well experienced pharmacogenomics. 13 00:01:23,860 --> 00:01:29,720 Industry leaders such as today's special guest and my name is Baas Sami, 14 00:01:29,730 --> 00:01:32,739 the co-host of PGX for Pharms podcast, 15 00:01:32,750 --> 00:01:33,860 Pharmacogenomics, 16 00:01:33,870 --> 00:01:36,819 medical science liaison and a mentor to pharmacist. 17 00:01:36,889 --> 00:01:40,239 Connect with us on linkedin and let's get a conversation going. 18 00:01:40,269 --> 00:01:46,720 We want to hear from you and how you're impacting pharmacogenomic stakeholders and what you have learned throughout your journey. 19 00:01:48,510 --> 00:01:49,010 Ok. 20 00:01:49,019 --> 00:01:50,819 So without any further ado, 21 00:01:50,839 --> 00:01:54,769 I'm extremely pleased to introduce to our audience. 22 00:01:54,919 --> 00:01:56,059 Doctor Theory Devo, 23 00:01:57,239 --> 00:02:01,129 the Chief Scientific Officer at Prometheus Laboratories, 24 00:02:01,139 --> 00:02:08,139 and Perme Prometheus Laboratories is a reference clinical laboratory that's focused on the diagnosis, 25 00:02:08,149 --> 00:02:13,330 prognosis and monitoring of immune mediated inflammatory diseases. 26 00:02:13,970 --> 00:02:14,229 So, 27 00:02:14,240 --> 00:02:14,649 thank you, 28 00:02:14,660 --> 00:02:17,759 Doctor De for joining us on the podcast. 29 00:02:17,770 --> 00:02:18,589 Today. 30 00:02:18,600 --> 00:02:23,190 I'm excited to share your and Prometheus's story with our audience. 31 00:02:23,649 --> 00:02:25,630 Um in particular, 32 00:02:25,639 --> 00:02:45,369 I'm excited about you sharing your career journey as a farm D phd and Chief scientific officer and designer of the Predictor PK AD A which is a precision guided dosing test for the optimization of Humira Remicade and their bio cylinders. 33 00:02:46,119 --> 00:02:46,449 So, 34 00:02:46,460 --> 00:03:04,220 one of Bana's and my main goals for this episode of the PGX for Pharmacist podcast is to expand our audience's notion of what a PGX test looks like and to inspire them to think bigger than the traditional box PGX test. 35 00:03:04,229 --> 00:03:08,020 Most of them or most of you are uh familiar with. 36 00:03:09,020 --> 00:03:09,429 So, 37 00:03:09,440 --> 00:03:22,179 Doctor D uh I'd like to start the podcast by having our guests um introduce themselves and elaborate on how you are a pharmacogenomics expert. 38 00:03:23,619 --> 00:03:23,800 Yeah, 39 00:03:23,809 --> 00:03:24,250 thank you, 40 00:03:24,259 --> 00:03:25,759 Becky for having me. 41 00:03:25,770 --> 00:03:26,850 Uh uh Yes. 42 00:03:26,860 --> 00:03:27,289 So I am a, 43 00:03:27,300 --> 00:03:30,820 I am a pharmacist uh with uh a family who is a, 44 00:03:30,830 --> 00:03:33,039 a doctorate in pharmacokinetics. 45 00:03:33,539 --> 00:03:44,520 Uh I completed my studies in France and I came as a postdoc uh fellow uh to work in the United States about 20 years ago to work on the pharmacogenomic of anti cancer agents, 46 00:03:44,929 --> 00:03:49,160 uh primarily uh six Maturin as well as methotrexate. 47 00:03:49,169 --> 00:03:50,550 After my post doc, 48 00:03:50,770 --> 00:03:52,960 uh I moved uh in industry for promet. 49 00:03:53,490 --> 00:04:01,429 So I have a large experience in uh uh the implementation of pharmacogenetics testing in immune mediated inflammatory disease. 50 00:04:01,509 --> 00:04:12,550 Our lab Rome was the first uh clinical laboratory in the United States to offer the fin uh metyl transfer genotyping as well as the thin metabolites. 51 00:04:12,559 --> 00:04:13,029 So, 52 00:04:13,050 --> 00:04:21,989 uh uh of uh of 70 publications in the field and uh I'm very uh very excited to have uh to be on the postcard with you uh uh today. 53 00:04:23,660 --> 00:04:24,220 All right. 54 00:04:24,230 --> 00:04:27,359 So thank you for qualifying yourself as an expert. 55 00:04:27,369 --> 00:04:27,619 So, 56 00:04:27,630 --> 00:04:32,839 let's jump right in and delve into your current PGX work. 57 00:04:32,850 --> 00:04:33,279 So, 58 00:04:33,489 --> 00:04:36,540 if you'll tell us um a little about Prometheus, 59 00:04:36,549 --> 00:04:38,000 specifically, 60 00:04:38,010 --> 00:04:40,350 what is Prometheus's mission? 61 00:04:40,359 --> 00:04:43,799 And how are you guys going about accomplishing your mission? 62 00:04:44,760 --> 00:04:44,980 Yeah, 63 00:04:44,989 --> 00:04:45,700 sure. 64 00:04:45,709 --> 00:04:47,459 Uh So Promet is a, 65 00:04:47,470 --> 00:04:52,790 is a reference uh clinical laboratory based in Southern California in San Diego. 66 00:04:53,230 --> 00:04:56,809 Uh The company has been there for uh over 25 years. 67 00:04:56,820 --> 00:05:03,950 We are uh specialize in the differential diagnosis of autoimmune G I disease uh disorders, 68 00:05:04,059 --> 00:05:06,019 uh gastrointestinal disorder, 69 00:05:06,230 --> 00:05:08,619 uh and inflammatory bowel disease. 70 00:05:08,980 --> 00:05:10,299 And over the years, 71 00:05:10,309 --> 00:05:16,600 we have developed a portfolio of a differentiated solution to facilitate the diagnosis, 72 00:05:16,609 --> 00:05:17,470 the prognosis, 73 00:05:17,480 --> 00:05:18,429 the monitoring, 74 00:05:18,660 --> 00:05:21,910 as well as therapy selection with pharmacogenetics testing, 75 00:05:21,920 --> 00:05:24,730 which we are offering to our clinical laboratory. 76 00:05:24,829 --> 00:05:26,350 And most importantly, 77 00:05:26,410 --> 00:05:27,299 uh recently, 78 00:05:27,309 --> 00:05:35,660 we are uh uh developing some uh uh testing solution with the credit topic care test to optimize treatment to uh biologics. 79 00:05:36,470 --> 00:05:37,130 Ok. 80 00:05:37,140 --> 00:05:37,329 Well, 81 00:05:37,339 --> 00:05:37,450 that, 82 00:05:37,459 --> 00:05:38,049 that's great. 83 00:05:38,059 --> 00:05:46,100 Can you also tell us uh about the Prois Library of Precision Medicine Tests for inflammatory bowel disease for patients? 84 00:05:46,109 --> 00:05:49,230 how they benefit medication therapy management. 85 00:05:49,239 --> 00:05:56,429 Stakeholders across the IB DS patients journey from diagnosis to treatment to disease, 86 00:05:56,440 --> 00:06:02,049 monitoring through remission and how they differ from other lab tests for IBD and his treatments. 87 00:06:02,709 --> 00:06:03,209 Yes. 88 00:06:03,220 --> 00:06:03,369 So, 89 00:06:03,380 --> 00:06:04,399 so we uh our, 90 00:06:04,410 --> 00:06:10,100 our clinical laboratory offers some uh highly specialized test to facilitate the, 91 00:06:10,109 --> 00:06:16,779 the diagnostic of uh to facilitate the differential diagnosis of uh uh inflammatory bowel disease. 92 00:06:16,790 --> 00:06:22,359 So we are following uh testing solution with uh serological testing, 93 00:06:22,529 --> 00:06:23,799 for example, 94 00:06:23,809 --> 00:06:38,410 uh uh piana as as as well as uh macro microbial uh uh antibodies that are present uh uh in Crohn's disease as well as uh over uh auto uh auto antibodies that are present in er colitis. 95 00:06:39,339 --> 00:06:43,684 These are conditions that are uh uh somewhat difficult to treat. 96 00:06:43,704 --> 00:06:49,994 Uh And uh we are uh uh offering those tests to uh help uh gastroenterologist. 97 00:06:50,015 --> 00:06:51,114 Uh uh first of all, 98 00:06:51,125 --> 00:07:03,434 to establish a differential diagnosis of IBD as compared to other uh condition typically uh uh irritable bowel syndrome as well as over gastrointestinal disorder. 99 00:07:03,445 --> 00:07:05,635 When the diagnostic is established, 100 00:07:05,910 --> 00:07:31,839 uh we offer uh testing to uh establish a prognosis where we're gonna in inform the clinician that the patient has a more aggressive uh disease that will require more aggressive treatment where uh we can uh provide the testing solution to initiate uh uh the most appropriate therapy for uh for the patient uh with uh a testing where we are uh basically uh you know, 101 00:07:31,850 --> 00:07:36,559 establish de determining some genotyping with the fit transferal genotyping. 102 00:07:36,570 --> 00:07:37,279 For example, 103 00:07:37,290 --> 00:07:40,250 where we can uh indicate that the patient is, 104 00:07:40,260 --> 00:07:45,079 is likely uh to present with a side effect to those medication. 105 00:07:45,399 --> 00:07:46,170 And once you know, 106 00:07:46,179 --> 00:07:47,799 the the treatment is initiative, 107 00:07:47,809 --> 00:08:16,089 we have a portfolio of solution uh to facilitate the monitoring of the disease of the inflammatory bowel disease as well as the dosing optimization with uh uh the answer test which uh measure blood level uh for uh uh monoclonal antibodies that are indicated in the treatment of IB start with starting with Infliximab Adalimumab as well as uh Tein and vidal. 108 00:08:16,980 --> 00:08:24,040 So we have a comprehensive portfolio to uh to surround the clinician with uh a variety of testing solution. 109 00:08:24,049 --> 00:08:30,250 With our goal being to improve the uh the outcome uh of patients with uh with diabetes. 110 00:08:30,260 --> 00:08:34,520 And I think that the pharmacist has a very important role to play from that perspective. 111 00:08:35,179 --> 00:08:36,039 So theory, 112 00:08:36,049 --> 00:08:40,239 could you elaborate for us more on the predictor test? 113 00:08:40,249 --> 00:08:42,758 Um especially since you designed that test, 114 00:08:42,768 --> 00:08:44,218 we'd really like to know, 115 00:08:44,489 --> 00:08:45,039 um you know, 116 00:08:45,049 --> 00:08:49,638 what did that take and what role does it play in your suite of testing? 117 00:08:51,049 --> 00:08:51,270 Yeah. 118 00:08:51,280 --> 00:08:51,890 Sure. 119 00:08:51,900 --> 00:08:52,510 So the, 120 00:08:52,520 --> 00:08:52,570 the, 121 00:08:52,580 --> 00:08:52,989 the, 122 00:08:53,000 --> 00:08:53,229 the, 123 00:08:53,239 --> 00:08:59,960 the predictor test is uh uh is uh is utilized when the patient is receiving treatment. 124 00:09:00,280 --> 00:09:18,190 It's been speci specifically designed to optimize uh biological uh uh disease modifiers such as Infliximab adalimumab that are co therapies in the treatment of inflammatory bowel disease as well as other immune uh mediated inflammatory. 125 00:09:18,200 --> 00:09:21,549 This is what the test does is to you connect the blood specimen, 126 00:09:22,229 --> 00:09:23,049 uh you know, 127 00:09:23,059 --> 00:09:24,750 with dosing information. 128 00:09:25,039 --> 00:09:41,989 And what we do is to uh uh provide guidance uh to clinician with uh respect of the best dose to give in order to achieve the best the level which is the most consistent with uh uh the disease control that needs to be achieved for the patient. 129 00:09:42,169 --> 00:09:43,729 Typically a vast majority, 130 00:09:43,739 --> 00:09:46,159 about two third of a third to two third, 131 00:09:46,169 --> 00:09:54,669 a third of patient uh tend to be uh uh unresponsive uh to this uh very expensive medication. 132 00:09:54,989 --> 00:09:57,960 Uh Not because they don't have the uh you know, 133 00:09:57,969 --> 00:09:59,289 typically because they have a, 134 00:09:59,299 --> 00:09:59,590 you know, 135 00:09:59,599 --> 00:10:05,599 pharmacokinetic uh suboptimal pharmacokinetic uh that makes them uh you know, 136 00:10:05,609 --> 00:10:09,440 unresponsive because uh not enough drug has been given. 137 00:10:09,450 --> 00:10:18,469 So what we do with a predictor test is to basically estimate the pa the pharmacokinetic uh parameter for the patient. 138 00:10:18,750 --> 00:10:24,729 And from then uh re report the best dose uh to give in order to achieve the, 139 00:10:24,760 --> 00:10:31,570 the level which is consistent with the uh the most uh uh effective disease control to be achieved for the patient. 140 00:10:32,169 --> 00:10:33,059 So we are offering, 141 00:10:33,070 --> 00:10:38,049 we have developed a test for the Infliximab as well as Adalimumab which is Humira, 142 00:10:38,909 --> 00:10:41,309 but these are antimony causes factor. 143 00:10:41,460 --> 00:10:49,549 And we are also developing the test for vidur as well as uh is that are widely used also in the treatment of, 144 00:10:49,559 --> 00:10:51,969 of uh inflammatory bubble disease. 145 00:10:51,979 --> 00:10:52,669 Wow, 146 00:10:52,679 --> 00:10:55,450 uh for MET is a suite of tests. 147 00:10:55,460 --> 00:11:00,940 Goes well beyond um the PGX testing that our audience is most familiar with, 148 00:11:01,299 --> 00:11:08,679 uh which typically only includes snips for cyp genes and some pharmacodynamic genes. 149 00:11:08,690 --> 00:11:31,424 This is really exciting um genes and biomarkers related to immunology are not commonly found in what I call the box PGX tests such as those uh made by large uh laboratory manufacturing companies um where the panel has a set number of genes and uh you know, 150 00:11:31,434 --> 00:11:36,054 it was developed by a larger laboratory for maybe smaller laboratories use. 151 00:11:36,729 --> 00:11:39,010 So my understanding, 152 00:11:39,020 --> 00:11:53,729 having talked with you extensively theory is that immunology has fewer PGX test available because it's actually more difficult say than oncology to research and develop tests. 153 00:11:53,739 --> 00:11:54,119 So, 154 00:11:54,130 --> 00:12:00,729 could you elaborate for our audience on the difficulties that are associated with immunology, 155 00:12:00,739 --> 00:12:05,830 research and developing tests uh for immunology versus say oncology? 156 00:12:06,330 --> 00:12:06,530 Yeah, 157 00:12:06,539 --> 00:12:07,049 sure. 158 00:12:07,059 --> 00:12:09,969 So in uh in immunology, 159 00:12:09,979 --> 00:12:11,590 as compared to oncology, 160 00:12:11,599 --> 00:12:17,169 there is no such a thing such as a somatic mutation where for example, 161 00:12:17,179 --> 00:12:18,429 you're gonna have a behalf, 162 00:12:18,440 --> 00:12:18,659 you know, 163 00:12:18,669 --> 00:12:20,349 that indicates that the patient, 164 00:12:20,679 --> 00:12:20,919 you know, 165 00:12:20,929 --> 00:12:25,239 is likely to benefit or not from some treatment in immunology. 166 00:12:25,250 --> 00:12:26,750 This is far more complicated, 167 00:12:26,760 --> 00:12:28,830 complicated for the reason, 168 00:12:29,239 --> 00:12:31,020 starting with uh the fact that, 169 00:12:31,030 --> 00:12:31,179 you know, 170 00:12:31,190 --> 00:12:36,219 the response to this uh medication uh are multifactorial. 171 00:12:36,260 --> 00:12:37,820 And the fact that uh you know, 172 00:12:37,830 --> 00:12:39,380 the mutation that uh the, 173 00:12:39,390 --> 00:12:39,619 the, 174 00:12:39,630 --> 00:12:45,190 the single nucleotide polymorphism in the GM line which uh uh you know, 175 00:12:45,200 --> 00:12:52,429 can potentially associate with uh with outcome uh uh uh uh a lo in advance, 176 00:12:52,440 --> 00:12:58,359 meaning that uh they're gonna have a weak association uh with a response to those medications. 177 00:12:58,369 --> 00:13:09,609 So there is a necessity in immunology to combine multiple genetic polymorphism together in order to achieve uh some uh performances characteristics that will make uh you know, 178 00:13:09,619 --> 00:13:09,859 the, 179 00:13:09,869 --> 00:13:10,380 the, 180 00:13:10,390 --> 00:13:10,520 the, 181 00:13:10,530 --> 00:13:13,219 the clinician uh you know, 182 00:13:13,419 --> 00:13:15,619 uh order the test and most importantly, 183 00:13:15,630 --> 00:13:15,840 the, 184 00:13:15,849 --> 00:13:16,179 the, 185 00:13:16,190 --> 00:13:17,739 the payer to pay for the test. 186 00:13:17,750 --> 00:13:20,469 So this field has been uh you know, 187 00:13:20,479 --> 00:13:20,679 is, 188 00:13:20,690 --> 00:13:21,705 is moving for, 189 00:13:21,715 --> 00:13:21,994 you know, 190 00:13:22,005 --> 00:13:24,575 there are some tests that are being developed right now. 191 00:13:24,924 --> 00:13:39,034 But the biggest challenge is to be able to achieve again the the threshold of uh of performance that makes the test is variable enough uh to be uh again ordered by the clinician and the utilize uh to the benefit of the patient. 192 00:13:39,659 --> 00:13:41,200 I couldn't agree with you more. 193 00:13:41,210 --> 00:13:53,489 Um I've worked on the payer side or market access side of pharmacogenomics and even uh with a box test for which there's um a lot of research data available, 194 00:13:53,500 --> 00:13:55,119 even with those, 195 00:13:55,130 --> 00:13:59,760 it's sometimes difficult uh to get payers um to see the value. 196 00:13:59,770 --> 00:14:01,640 So I absolutely agree with you. 197 00:14:01,940 --> 00:14:03,679 Um The fact that you guys are, 198 00:14:03,690 --> 00:14:11,789 are uh investing in producing the data necessary says a lot about your laboratory. 199 00:14:11,979 --> 00:14:12,559 Um you know, 200 00:14:12,570 --> 00:14:15,380 and how committed you are to this testing and, 201 00:14:15,390 --> 00:14:17,320 and how you believe in the testing. 202 00:14:18,039 --> 00:14:23,640 So I just want to make sure that our audience recognizes that, 203 00:14:24,359 --> 00:14:24,619 you know, 204 00:14:24,630 --> 00:14:31,820 Prometheus doesn't simply provide tests to determine if drugs for IBD will be effective and safe. 205 00:14:32,190 --> 00:14:36,900 Um And maybe what the dose of the drug should be for the patient, 206 00:14:36,909 --> 00:14:40,219 but you have that whole suite of tests. 207 00:14:40,229 --> 00:14:47,380 Um the diagnostic test for the differential diagnosis all the way through remission. 208 00:14:48,030 --> 00:14:53,390 So can you elaborate you elaborated on it some in the previous question? 209 00:14:53,400 --> 00:15:01,229 But um can you tell us the difference between how you had to actually develop the test? 210 00:15:01,520 --> 00:15:02,530 Um You didn't, 211 00:15:02,539 --> 00:15:03,059 in other words, 212 00:15:03,070 --> 00:15:10,659 purchase a test from another manufacturer with the biomarkers that you include in your testing. 213 00:15:10,669 --> 00:15:16,830 Can you elaborate on how much more difficult it is to to develop a test from scratch? 214 00:15:18,169 --> 00:15:18,320 Yeah, 215 00:15:18,330 --> 00:15:18,659 sure. 216 00:15:18,669 --> 00:15:18,809 I mean, 217 00:15:18,820 --> 00:15:22,070 this is this is challenging for multiple and first of all, 218 00:15:22,080 --> 00:15:23,130 you need to have the, 219 00:15:23,419 --> 00:15:27,450 you need to have a clinical data set available with specimen available. 220 00:15:27,460 --> 00:15:28,159 Uh you know, 221 00:15:28,169 --> 00:15:28,780 in front, 222 00:15:28,859 --> 00:15:29,770 obviously, 223 00:15:29,859 --> 00:15:30,890 available. 224 00:15:31,200 --> 00:15:35,890 Uh So we are leveraging a pro meters a large bi bank of specimen. 225 00:15:36,299 --> 00:15:37,190 Uh as I said, 226 00:15:37,200 --> 00:15:39,719 Prometheus has been founded 25 years ago. 227 00:15:39,729 --> 00:15:40,599 So over the, 228 00:15:40,760 --> 00:15:41,919 the past two decades, 229 00:15:41,929 --> 00:15:54,849 we have been able to assemble a large uh substrate of data and specimen which we are uh uh using to uh uh establish our proof of concept if you will. 230 00:15:54,859 --> 00:16:07,559 And then when we have uh identify some genetic polymorphism that are uh adequately uh associated with uh uh disease outcome and disease progression as well as uh toxicity. 231 00:16:07,969 --> 00:16:11,469 Then we are entering validation phase where we are uh you know, 232 00:16:11,570 --> 00:16:14,789 using validation cohorts where we are again, 233 00:16:14,969 --> 00:16:22,630 combining multiple modalities together uh patient demographic as well as genetic marker together with theological marker. 234 00:16:22,640 --> 00:16:23,190 Actually, 235 00:16:23,500 --> 00:16:27,419 to come up with some Multivariate models that are uh again, 236 00:16:27,429 --> 00:16:39,250 bringing the performances characteristics of the pharmacogenomic test or its combination with our marker to the level where it's supposed to be in the first place to meet uh uh payer. 237 00:16:39,650 --> 00:16:41,190 And uh obviously, 238 00:16:41,200 --> 00:16:41,760 again, 239 00:16:41,770 --> 00:16:45,320 the patient uh to the benefit of the patient and to, 240 00:16:45,330 --> 00:16:46,619 to improve its outcome, 241 00:16:46,739 --> 00:16:47,429 the outcome. 242 00:16:48,340 --> 00:16:53,380 I think what you're describing really is the future of pharmacogenomics. 243 00:16:53,390 --> 00:16:54,599 Um In other words, 244 00:16:54,609 --> 00:17:03,419 not singing out pharmacogenomics as you know the end all and be all in the treatment paradigm. 245 00:17:03,559 --> 00:17:08,040 But using a PGX test in combination with, 246 00:17:08,050 --> 00:17:09,069 like you mentioned, 247 00:17:09,250 --> 00:17:11,160 other serological tests, 248 00:17:11,170 --> 00:17:12,959 maybe other genetic tests. 249 00:17:13,290 --> 00:17:14,890 Um But you know, 250 00:17:14,900 --> 00:17:25,869 I think what we want our audience to really wrap their heads around is that PGX is just a piece of that larger puzzle um from diagnosis to treatment to, 251 00:17:25,880 --> 00:17:26,910 to remission. 252 00:17:27,239 --> 00:17:29,880 So I think you guys are absolutely, 253 00:17:29,890 --> 00:17:31,579 you're already in the future. 254 00:17:31,589 --> 00:17:32,849 In other words, 255 00:17:32,859 --> 00:17:33,130 you know, 256 00:17:33,140 --> 00:17:39,689 you're already providing all these different uh tests um like you mentioned to, 257 00:17:39,699 --> 00:17:44,310 to facilitate from diagnosis to remission to remission. 258 00:17:44,660 --> 00:17:45,520 That's correct. 259 00:17:45,530 --> 00:17:45,829 Yeah. 260 00:17:46,349 --> 00:17:55,089 So um you've given us so much great information about uh the tests that that you guys offer. 261 00:17:55,329 --> 00:18:02,060 Can you explain to our audience um your newest test? 262 00:18:02,069 --> 00:18:03,859 Uh the responder test. 263 00:18:04,150 --> 00:18:12,979 And um what role it will play in the paradigm from the diagnosis of IBD to remission? 264 00:18:14,050 --> 00:18:14,260 Yeah, 265 00:18:14,270 --> 00:18:14,760 sure. 266 00:18:14,770 --> 00:18:15,569 So we, 267 00:18:15,579 --> 00:18:18,069 we are doing things a little bit different than other. 268 00:18:18,079 --> 00:18:19,489 We do believe that uh you know, 269 00:18:19,500 --> 00:18:21,449 the it has to be simple. 270 00:18:21,459 --> 00:18:24,189 Uh uh We can obviously construct some very, 271 00:18:24,199 --> 00:18:33,530 very complex algorithm and there are some tests that do that with a very sophisticated machine learning based tools that are available using neural networks, 272 00:18:33,540 --> 00:18:33,729 you know, 273 00:18:33,739 --> 00:18:34,790 those sorts of things. 274 00:18:34,800 --> 00:18:39,729 But we have taken on a different approach where with the responder test, 275 00:18:39,739 --> 00:18:40,329 we are basically, 276 00:18:40,339 --> 00:18:45,160 we are taking an approach which is very simple to address the first and foremost. 277 00:18:45,170 --> 00:18:53,020 Most important aspect of responding uh predicting response to uh to medication is the pharmacokinetics. 278 00:18:53,280 --> 00:19:03,250 Uh You cannot be responding to a drug if the drug is not given and you obviously cannot respond to a drug if the drug is not metabolized adequately. 279 00:19:03,359 --> 00:19:06,349 And this is what we are doing with the responder test. 280 00:19:06,579 --> 00:19:09,010 We are addressing some uh uh you know, 281 00:19:09,020 --> 00:19:11,630 fundamental issues with those uh biologist, 282 00:19:11,640 --> 00:19:12,410 for example, 283 00:19:12,660 --> 00:19:15,170 uh the anti tumor necrosis factors. 284 00:19:15,180 --> 00:19:15,650 So, 285 00:19:15,750 --> 00:19:19,199 such as uh Infliximab and Adalimumab, 286 00:19:19,209 --> 00:19:23,050 it is well known uh that uh uh those drugs, 287 00:19:23,060 --> 00:19:25,689 first of all are prone to immunization. 288 00:19:25,989 --> 00:19:36,949 Uh Meaning that uh uh the drug itself uh is recognized by the immune system uh and digested by the antigen presenting cells. 289 00:19:36,959 --> 00:19:42,209 If you will uh where you gonna have uh uh an immune uh uh response, 290 00:19:42,380 --> 00:19:56,979 uh mounted a cancer drug to produce uh immunogen that will severely impact its pharmacokinetics where the labels will be inadequate to produce uh the desired uh anti-inflammatory effects. 291 00:19:56,989 --> 00:19:57,150 So, 292 00:19:57,160 --> 00:19:58,890 we are with the risk conductors, 293 00:19:58,900 --> 00:20:01,040 we are combining two things together. 294 00:20:01,189 --> 00:20:07,959 First of all is the genetic test itself which uh predicts the risk of immun immunization. 295 00:20:07,969 --> 00:20:18,010 The name of the test is on HL A uh DQ A 105 ali uh that uh uh promotes the presentation of the, 296 00:20:18,020 --> 00:20:19,130 of the, 297 00:20:19,140 --> 00:20:19,910 of Infliximab, 298 00:20:20,010 --> 00:20:20,750 for example, 299 00:20:20,760 --> 00:20:32,130 to the T cell repertoire in order to uh promote the Ronon expansion and the formation of the anti antibodies together with uh another dimension which is the clearance, 300 00:20:32,140 --> 00:20:33,670 which is as important. 301 00:20:33,949 --> 00:20:36,209 Uh One of the key issue is the, 302 00:20:36,219 --> 00:20:36,770 the, 303 00:20:36,780 --> 00:20:41,239 the monoclonal antibodies and uh such as Infliximab or Adalimumab. 304 00:20:41,329 --> 00:20:42,280 But in fact, 305 00:20:42,290 --> 00:20:45,890 a neon antibodies that those drugs are uh you know, 306 00:20:45,900 --> 00:20:49,010 cleared and consumed uh from the, 307 00:20:49,020 --> 00:20:50,949 from the central compartment if you will, 308 00:20:50,959 --> 00:20:54,520 since we are doing a little bit of uh uh pharmacokinetics here. 309 00:20:54,530 --> 00:20:56,020 And uh uh you know, 310 00:20:56,030 --> 00:21:06,670 if the patient present who is uh a high degree of inflammatory burden is gonna have uh the patient will have a high clearance and that's gonna worsen uh in the, 311 00:21:06,680 --> 00:21:13,939 in the presence again of the HL AD Q A 105 genetic marker that uh associate with uh immunization. 312 00:21:13,949 --> 00:21:16,859 So I but this is a combination of both, 313 00:21:17,199 --> 00:21:19,359 these are the predictive factors of pharmacokinetic, 314 00:21:20,359 --> 00:21:38,209 which we combine together where the patient presenting with a risk of immunization as well as accelerated clearance due to the fact that the patient has high inflammation or due to the fact that they are so intrinsic pharmacokinetic properties that makes that the patient, 315 00:21:38,219 --> 00:21:38,300 you know, 316 00:21:38,310 --> 00:21:39,479 will clear the drug very, 317 00:21:39,489 --> 00:21:40,260 very fast. 318 00:21:40,560 --> 00:21:41,670 For example, 319 00:21:41,680 --> 00:21:46,819 due to the inefficient uh recirculation of the drug itself with the new, 320 00:21:46,869 --> 00:21:46,930 the, 321 00:21:46,939 --> 00:21:50,599 the the in the reticular on the system. 322 00:21:50,920 --> 00:21:51,619 Together, 323 00:21:51,630 --> 00:22:02,109 those patients presenting with uh uh together these uh poor prognostic factor of pharmacokinetic origin will tend to be severely underdose, 324 00:22:02,380 --> 00:22:06,719 will not be responding to the drug uh adequately as and they, 325 00:22:06,729 --> 00:22:10,719 and they probably should in the first place if you are able to address uh you know, 326 00:22:10,729 --> 00:22:12,270 the the the exposure. 327 00:22:12,439 --> 00:22:14,079 So what we do with this test, 328 00:22:14,089 --> 00:22:21,640 we will be able to inform uh the clinic that the patient is at risk of achieving, 329 00:22:21,650 --> 00:22:30,829 of achieving suboptimal pharmacokinetics and therefore being able to adjust the dose uh uh to start with more adequately. 330 00:22:30,839 --> 00:22:38,650 So that the the the proper uh exposure is achieved uh during induction to again to, 331 00:22:38,660 --> 00:22:39,040 to, 332 00:22:39,050 --> 00:22:39,380 to, 333 00:22:39,390 --> 00:22:40,890 to achieve a better outcome. 334 00:22:41,040 --> 00:22:47,270 And I think the pharmacist will have a very important role to play here in terms of absolutely, 335 00:22:47,280 --> 00:22:51,239 that information is priceless in the management of these medications. 336 00:22:51,250 --> 00:22:54,930 So thanks for elaborating on that. 337 00:22:56,010 --> 00:22:59,040 And if I may add in our previous conversation, 338 00:22:59,050 --> 00:23:00,810 uh before the recording of podcast, 339 00:23:00,819 --> 00:23:08,869 we had discussed um you guys' robust platform for collaborating with payers to obtain market access and reimbursements for the test. 340 00:23:09,109 --> 00:23:14,109 But without stealing the Thunder from uh Prometheus market access and reimbursement team, 341 00:23:14,199 --> 00:23:22,619 can you please uh briefly detail how Prometheus has proactively worked with payers to solve the problem. 342 00:23:22,920 --> 00:23:27,349 Um the population health problem by building the evidence payers want, 343 00:23:27,359 --> 00:23:41,170 want to see um about your test before you go to the market and then build the test and then hope the payers will see the value and the result and then that will improve the market access and reimbursement for your um precision medicine test. 344 00:23:42,160 --> 00:23:42,339 Yeah. 345 00:23:42,349 --> 00:23:43,180 So briefly I can, 346 00:23:43,189 --> 00:23:43,579 I'm, 347 00:23:43,589 --> 00:23:46,619 I'm probably not the right person to answer that question. 348 00:23:46,630 --> 00:23:47,369 We have a very, 349 00:23:47,380 --> 00:23:52,400 very efficient market access group uh uh pro meters that does a splendid job. 350 00:23:52,410 --> 00:23:59,780 But uh uh uh what I can tell you that we have an evidence uh uh development plan in place where we, 351 00:23:59,790 --> 00:24:14,000 we are establishing the clinical utility of our testing solution by demonstrating uh the payer value uh with respect of uh patient management and uh uh and the, 352 00:24:14,010 --> 00:24:16,630 and the impact of our technology on the, 353 00:24:16,640 --> 00:24:18,119 on physician behavior. 354 00:24:18,430 --> 00:24:21,319 Uh We have uh uh already uh you know, 355 00:24:21,329 --> 00:24:25,160 commercialized uh two of those tests for which we have initiated, 356 00:24:25,170 --> 00:24:29,040 initiated the Power studies uh that uh uh you know, 357 00:24:29,050 --> 00:24:32,000 already provide uh you know, 358 00:24:32,104 --> 00:24:34,484 differentiated and the value to, 359 00:24:34,494 --> 00:24:35,915 to the payer where we are, 360 00:24:35,925 --> 00:24:36,025 the, 361 00:24:36,035 --> 00:24:46,005 the clinicians are basically using our technology to make treatment decision uh as well as uh some prospective clinicality study which we are initiating, 362 00:24:46,145 --> 00:24:47,555 initiating to. 363 00:24:47,564 --> 00:24:48,574 Um uh again, 364 00:24:48,584 --> 00:24:49,425 demonstrate the, 365 00:24:49,435 --> 00:24:49,915 the, 366 00:24:49,925 --> 00:24:50,244 the, 367 00:24:50,255 --> 00:24:53,594 the payer value you uh uh we can certainly follow up with, 368 00:24:53,604 --> 00:24:58,755 uh you can certainly follow up with our market access group uh uh as appropriate there. 369 00:24:58,765 --> 00:25:00,765 Uh They can fill you with more information. 370 00:25:01,349 --> 00:25:01,589 No, 371 00:25:01,599 --> 00:25:02,520 that totally makes sense. 372 00:25:02,530 --> 00:25:03,310 That totally makes sense. 373 00:25:03,319 --> 00:25:10,890 But um we're excited that you're also farm d So how did you get to this role of outside the box path? 374 00:25:10,900 --> 00:25:11,550 There? 375 00:25:11,640 --> 00:25:17,530 There may be a pharmacist student or pharmacist wanting to switch or transition into a role such as yours, 376 00:25:17,540 --> 00:25:19,609 which is a Chief Scientific Officer. 377 00:25:19,619 --> 00:25:20,609 I want to learn more. 378 00:25:20,619 --> 00:25:23,920 So how would you um can you talk a little bit about that? 379 00:25:24,560 --> 00:25:24,780 Well, 380 00:25:24,790 --> 00:25:26,270 we are clinical laboratories. 381 00:25:26,280 --> 00:25:29,400 So in order to uh uh to be in my role, 382 00:25:29,410 --> 00:25:34,020 you need to have uh uh you need to have expertise in clinical laboratory science. 383 00:25:34,030 --> 00:25:36,140 So for the students is basically, 384 00:25:36,150 --> 00:25:36,300 you know, 385 00:25:36,310 --> 00:25:40,770 to do the family degree and then complete the family degree with uh a doctorate, 386 00:25:40,780 --> 00:25:40,930 you know, 387 00:25:40,939 --> 00:25:44,260 which is uh focus on clinical laboratory science. 388 00:25:44,270 --> 00:25:46,079 So you can achieve uh uh you know, 389 00:25:46,089 --> 00:25:47,640 the all the elements you need to be, 390 00:25:47,650 --> 00:25:48,219 for example, 391 00:25:48,229 --> 00:25:53,189 board certified uh as uh as as medical laboratory director. 392 00:25:53,199 --> 00:25:55,160 So you can uh uh so, 393 00:25:55,170 --> 00:25:55,589 uh yeah, 394 00:25:55,599 --> 00:25:56,030 this is, 395 00:25:56,040 --> 00:25:56,400 this is, 396 00:25:56,410 --> 00:25:57,209 this is uh you know, 397 00:25:57,219 --> 00:25:59,160 a great opportunity I think for pharmacies, 398 00:25:59,170 --> 00:26:10,800 there is an absolute need to uh have the clinical pharmacist provide uh uh drug information to healthcare professional as well as uh assist patient with the monitoring of their disease, 399 00:26:10,810 --> 00:26:15,229 the effectiveness of the therapy and um and uh you know, 400 00:26:15,239 --> 00:26:16,060 monitoring the, 401 00:26:16,069 --> 00:26:20,969 the side effect and the toxicity from uh from those uh those medication. 402 00:26:24,650 --> 00:26:24,959 Well, 403 00:26:24,969 --> 00:26:32,119 the I know our audience is going to have uh additional questions for you. 404 00:26:32,130 --> 00:26:32,540 I mean, 405 00:26:32,989 --> 00:26:35,609 you've provided them with so much great information, 406 00:26:35,619 --> 00:26:44,959 but it's only the beginning of what they could possibly learn um about um the testing that you do for IBD and, 407 00:26:44,969 --> 00:26:46,729 and even your career path. 408 00:26:47,050 --> 00:26:47,530 So, 409 00:26:47,540 --> 00:26:49,300 if you wouldn't mind telling us, 410 00:26:49,310 --> 00:26:51,359 um because we have to wrap up, 411 00:26:51,369 --> 00:26:52,670 unfortunately, 412 00:26:53,150 --> 00:26:55,810 this episode of the podcast, 413 00:26:55,819 --> 00:27:00,250 uh could you tell us how our audience members might be able to contact you directly. 414 00:27:01,260 --> 00:27:01,449 Yeah, 415 00:27:01,459 --> 00:27:07,079 I can be contacted on my uh on my email at TT W at como slab dot com. 416 00:27:07,949 --> 00:27:08,810 All right. 417 00:27:09,069 --> 00:27:09,300 Well, 418 00:27:09,310 --> 00:27:14,290 thank you again so much uh for joining us on this episode. 419 00:27:14,300 --> 00:27:15,290 We really, 420 00:27:15,300 --> 00:27:29,530 really hope that our listeners um ideas of not only what PGX can be but how PGX can be utilized in a comprehensive testing suite. 421 00:27:29,709 --> 00:27:35,670 We really hope that our a our audience will um listen in and learn this information. 422 00:27:36,280 --> 00:27:37,869 Um And to our audience, 423 00:27:37,880 --> 00:27:39,439 thank you for tuning in. 424 00:27:39,449 --> 00:27:42,619 We really hope that you've learned from this episode. 425 00:27:43,130 --> 00:27:46,339 Uh We do a whole lot of PG Xing here on this podcast. 426 00:27:46,349 --> 00:27:48,380 We talk about PGX Science, 427 00:27:48,390 --> 00:27:52,030 clinical application and the business of PGX. 428 00:27:52,260 --> 00:27:54,880 So we'd love to hear about from you. 429 00:27:55,099 --> 00:27:56,479 I love to hear from you. 430 00:27:56,489 --> 00:27:58,439 Um What can we teach you? 431 00:27:58,449 --> 00:28:00,920 What more can we teach you through our podcast? 432 00:28:00,930 --> 00:28:12,349 So please drop us a message on linkedin and let us know and please share this link to this podcast link episode with everyone so they can tune in and listen to the PGX for promises podcast. 433 00:28:12,520 --> 00:28:15,369 Leave us a review on Apple podcast or Spotify. 434 00:28:15,459 --> 00:28:18,130 And you can also visit us on PGX four, 435 00:28:18,140 --> 00:28:22,989 the number four Rx dot com to listen to all our other episodes. 436 00:28:23,000 --> 00:28:23,079 Well, 437 00:28:23,089 --> 00:28:23,790 thank you. 438 00:28:24,199 --> 00:28:28,750 Thanks for your interest in PGX and for spending some time with us. 439 00:28:28,760 --> 00:28:35,670 Please share this podcast and leave us a review on Apple podcasts or Spotify for all of our episodes. 440 00:28:35,680 --> 00:28:39,390 Please visit PGX four Rx dot com. 441 00:28:39,569 --> 00:28:43,380 That's PGX four Rx dot com.  

DocTalk Podcast
Autoimmune Hepatitis at ACG 2023, with Gina Choi, MD

DocTalk Podcast

Play Episode Listen Later Oct 25, 2023 15:51


Episode Highlights 0:12 Intro 1:24 Challenges in autoimmune hepatitis 3:30 Patient demographics 4:25 Diagnostic challenges 6:35 What is overlap syndrome? 8:04 Mysteries behind immune dysregulation 9:05 Promising drugs in investigation 10:51 The BAFF receptor target 11:41 Infliximab & rituximab 12:38 An autoimmune hepatitis wishlist 15:29 Outro Autoimmune hepatitis (AIH), a rare liver disease characterized by an unclear driver of inflammation, is historically challenged by limited clinical understanding, a slow development of treatment options in investigation, and a nonetheless concerning prognosis for affected adults and children. While some prospects are in development to aid specialists in adequately identifying risk factors for, diagnosing and treating AIH, education and communication on those developments is vital. In an interview with HCPLive during the American College of Gastroenterology (ACG 2023) Annual Scientific Meeting in Vancouver, BC this week, Gina Choi, MD, associator clinical professor of medicine and surgery at UCLA Health, discussed the ins and outs of modern autoimmune liver disease research and development.  Including the treatment pipeline and current standards for diagnostics, Choi additionally discussed the sociodemographic and pathophysiological traits of AIH burden—as well as the lesser-known overlap syndrome. For more hepatology and gastroenterology coverage from ACG 2023, visit us at https://www.hcplive.com/conference/acg.

In conversation with...
Edouard Louis on the SPARE trial of infliximab or immunosuppressant withdrawal in Crohn's disease

In conversation with...

Play Episode Listen Later Feb 8, 2023 21:30


Edouard Louis (University Hospital CHU of Liège) discusses the SPARE randomised controlled trial of infliximab or concomitant immunosuppressant withdrawal in patients with Crohn's disease.Read the full article:Withdrawal of infliximab or concomitant immunosuppressant therapy in patients with Crohn's disease on combination therapy (SPARE)Continue this conversation on social!Follow us today at...https://twitter.com/thelancethttps://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

MedLink Neurology Podcast
BrainWaves #153 Neurosarcoidosis: The 21st century great mimicker

MedLink Neurology Podcast

Play Episode Listen Later Feb 2, 2023 34:21


MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: December 12, 2019 In the TV show, HOUSE, it's either lupus or its sarcoidosis. Only, it's never sarcoidosis. That's because sarcoidosis is such a heterogeneous condition and can affect practically any age group. In some patients, this idiopathic inflammatory disorder can also involve the nervous system. Also causing a variety of signs and symptoms ranging from mild headache to a proximal myopathy or even a CNS vasculitis. This week on the BrainWaves podcast, Dr. Jesse Thon reflects on the literature and shares his experience managing patients with this troubling condition. Produced by Jesse Thon and James E Siegler. Music courtesy of Steve Combs, Lovira, and Yakov Goldman. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @BrainWavesaudio for the latest updates to the podcast. REFERENCESAgbogu BN, Stern BJ, Sewell C, Yang G. Therapeutic considerations in patients with refractory neurosarcoidosis. Arch Neurol 1995;52(9):875-9. PMID 7661724Agnihotri SP, Singhal T, Stern BJ, Cho TA. Neurosarcoidosis. Semin Neurol 2014;34(4):386-94. PMID 25369434Baughman RP, Drent M, Kavuru M, et al. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med 2006;174(7):795-802. PMID 16840744Baughman RP, Lower EE. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2001;18(1):70-4. Erratum in: Sarcoidosis Vasc Diffuse Lung Dis 2001;18(3):310. PMID 11354550Bitoun S, Bouvry D, Borie R, et al. Treatment of neurosarcoidosis: a comparative study of methotrexate and mycophenolate mofetil. Neurology 2016;87(24):2517-21. PMID 27856779Gelfand JM, Bradshaw MJ, Stern BJ, et al. Infliximab for the treatment of CNS sarcoidosis: a multi-institutional series. Neurology 2017;89(20):2092-00. PMID 29030454Jolliffe EA, Keegan BM, Flanagan EP. Trident sign trumps Aquaporin-4-IgG ELISA in diagnostic value in a case of longitudinally extensive transverse myelitis. Mult Scler Relat Disord 2018;23:7-8. PMID 29709797Petereit HF, Reske D, Tumani H, et al. Soluble CSF interleukin 2 receptor as indicator of neurosarcoidosis. J Neurol 2010;257(11):1855-63. PMID 20556411Rossman MD, Newman LS, Baughman RP, et al. A double-blinded, randomized, placebo-controlled trial of infliximab in subjects with active pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2006;23(3):201-8. PMID 18038919Wallaert B, Ramon P, Fournier EC, et al. High-dose methylprednisolone pulse therapy in sarcoidosis. Eur J Respir Dis 1986;68(4):256-62. PMID 3732422We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's

UEG Journal
UEG Journal Best Paper Award 2022 - Combining biologics and small molecules in IBD

UEG Journal

Play Episode Listen Later Sep 26, 2022 13:54


Katarzyna Pawlak talks to Dr Goessens (Belgium) about his recent paper on the efficacy and safety of combining biologic agents and small molecules in IBD, recognized with the UEG Journal 2022 Best Paper Award.

MPR Weekly Dose
MPR Weekly Dose MPR 119 — FDA Panel Votes on Novavax; MMR Vaccination; Dupixent Approval Expanded; Investigative COVID-19 Treatments

MPR Weekly Dose

Play Episode Listen Later Jun 10, 2022 15:36


The FDA Advisory Committee vote on Novavax; new option for MMR vaccination; Dupixent approval expanded; and we take a look at the latest data on COVID-19 treatments.

Evidence-Based GI: An ACG Publication and Podcast
Therapeutic Drug Monitoring of Maintenance Infliximab Is Beneficial for Patients with Immunemediated Inflammatory Diseases

Evidence-Based GI: An ACG Publication and Podcast

Play Episode Listen Later Apr 14, 2022 11:07


JAMA Editors' Summary: On research in medicine, science, & clinical practice. For physicians, researchers, & clinicians.
Maintenance Infliximab for Immune-Mediated Inflammatory Diseases, Omega-3 Fatty Acids for Depression, DOACs and Atrial Fibrillation, and more

JAMA Editors' Summary: On research in medicine, science, & clinical practice. For physicians, researchers, & clinicians.

Play Episode Listen Later Dec 21, 2021 11:38


Editor's Summary by Gregory Curfman, MD, Deputy Editor of JAMA, the Journal of the American Medical Association, for the December 21, 2021 issue.

IBD Heal
Self Healing Crohn's Disease with a Plant based Diet

IBD Heal

Play Episode Listen Later Dec 20, 2021 41:48


Today's episode is about how Sam healed Crohn's Disease. Free consultation with High Carb Health: https://www.highcarbhealth.com/healthsurvey/ Self Healing Crohn's Disease with a Plant-based diet: I was diagnosed with Crohn's disease in 2007. I wanted to try to control this naturally, so I was careful about what I was eating. But over time it got worse. So I ended up on various medications, for example, Budesonide, Azathioprine, Pentasa, Infliximab and Mercaptopurine. Then in 2012, I had to have surgery to remove a section of the small intestine, large intestine and appendix. After the surgery, I felt so much better and life seemed to go back to normal. But then in 2014, the disease became active again, so I was put back on Mercaptopurine. I didn't really want to be taking this medication because of the side effects, but there seemed no other option. As it turns out I felt well on this medication and so continued taking it. The Doctors had told me this medication was for life. Then in 2020 one of my friends introduced me to High Carb Health. I looked on the website, read all about Shamiz and read loads of the testimonials. I thought a lot about it before I actually booked the free consultation. The consultation was very thought-provoking and Shamiz was so kind and caring that I thought there really must be something to this program. So many people have been helped, why not me? The consultation made me want to go plant-based, so overnight, I did. This helped when later I decided to do the 3-month program, the detox wasn't as bad because my body had already started to heal. I had some hair loss, aches and pains, skin rashes but my stools were “normal”. This was a very exciting part of the journey. I could feel myself getting better as each week went by. The support and guidance from Shukul each week was so valuable, there is no way I could have done this on my own. Now I feel I have the knowledge to keep healing and to stay symptom-free. My life now only 5 months since I started the program, is so very different, I am no longer taking medication, the one I was told was for life. I am symptom-free and mentally free from always wondering where the nearest toilet is. I have become much more positive as a result of the 5 key steps, food, water, sleep, exercise and mindfulness, and I am able to enjoy life so much more. Thank you to HCH for helping me heal. To anyone thinking about doing the program and taking control of your health and getting your life back, please do it, you will not regret it.

IBD Heal
Declan's Incredible Story of Healing Crohn's Disease

IBD Heal

Play Episode Listen Later Nov 8, 2021 58:25


Check out Declan's story on how he has been able to reverse Crohn's disease via a plant-based diet. He has been through so much and lost almost all his hair due to medications. This is a raw and real testimonial of someone who has really taken control of their health. He is so pleased with his progress he couldn't wait to share his story with everyone. Hope you guys can get something out of this and also heal your disease! Free Consultation with High Carb Health: https://www.highcarbhealth.com/healthsurvey/ 37 years old and life was full, fast and exciting when it took a sudden turn. Perhaps not so much a turn, but a sudden neck-breaking stop! I had begun the year in New York working a contract, then had a trip to India and was back in Ireland awaiting my transfer back to New York for more work when my body "failed me". As the months wore on and my job opportunity passed me by, I was now 37 years old; stuck on my parent's couch unable to function or live any form of life. The doctors, the bloods, the specialists, the colonoscopy's, more bloods, endoscopy's, diagnosis, misdiagnosis, MRI scans, more bloods, steroids, Pentasa and a feeling of achievement every time I could go for a short walk or meet a friend for an hour, life was unrecognizable. By the time I was diagnosed with Crohn's I was ecstatic. It proved I wasn't crazy. Oh, how ignorance is bliss. In January 2018 a doctor could have handed me opium and I would have taken it with zeal but instead, I was given Infliximab (biologic) and began to claw my life back bit by bit. Over the next year, I would realize that doctors should say when diagnosing you that you have a choice between the side effects of drugs and the symptoms of the disease but that you will never be well again. Nausea was a persistent pest, weight gain, memory loss, acne and finally Telogen Effluvium - the loss of my hair. I was switched from Infliximab to Entyvio and pains in my heals and arms soon replaced the nausea. A desperate feeling of isolation and helplessness befell me. I lay in an oncology ward, Entyvio pumping into my veins - numb - a pawn in a game. The game I came to realize was a disease misunderstood by the medical profession where doctors try this, try that, a bit more of this, a bit less of that, using drugs never designed for this cursed disease. It was all a game of chance, trial and error. After 6 months of Entyvio, the nausea soon returned followed by a flare. I had had enough of this unwinnable game! I realized if this was the best I could hope for with the disease mostly in remission and mild as a specialist described it if this was the blueprint of my life to come then how was I ever to live with the normal stresses and challenges of life? Move jobs? Travel? Have kids? Deal with bereavement? Each time you feel well you simply turn the egg timer over and wait for the next "something" to strike. You live your life in hindsight, never enjoying the moment. There had to be another way. There had to be an answer to this. I found High Carb Health in June 2019. Now thanks to those two wonderful men I play by my own rules - free of medications and this disease. I am fully back in control of my body and my life. The future is ... well, I have one! HCH taught me that my body hadn't "failed me" - I had failed it. I had found the ESCAPE key from this game!

This Week in Virology
TWiV 814: COVID-19 clinical update #83 with Dr. Daniel Griffin

This Week in Virology

Play Episode Listen Later Oct 9, 2021 49:49


In COVID-19 clinical update #83, Daniel Griffin discusses upcoming FDA discussions on vaccines, strategies to prevent transmission at youth camps, outbreaks at summer camps, impact of vaccination on transmission, AZD7442 request for EUA filed, EUA issued for home antigen test, phase 3 data on AZD1222 vaccine, 6 month effectiveness of Pfizer/BioNTech vaccine, estimates of durability of immunity against reinfection, Molnupiravir interim results, optimal time for monoclonal antibody infusion, IVIG plus Infliximab for MIS-C, and effect of vaccination on long COVID. Hosts: Daniel Griffin and Vincent Racaniello Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Preventing transmission at camps (MMWR) Outbreaks at summer camps (MMWR) Impact of vaccination on transmission (medRxiv) AZD7442 request for FDA EUA (AstraZeneca) FDA EUA for home antigen test (FDA) Phase 3 results AZD1222 vaccine (NEJM) 6 month effectiveness BNT1`62b2 vaccine (Lancet) Durability of immunity vs reinfection (Lancet) Molnupiravir interim results (Merck) Optimal time for mAb therapy (Inf Dis Advisor) IVIG plus Infliximab for MIS-C (Pediatrics) Effect of vaccination on long COVID (Lancet preprint) Letters read on TWiV 814 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

This Week in Virology
TWiV 814: COVID-19 clinical update #83 with Dr. Daniel Griffin

This Week in Virology

Play Episode Listen Later Oct 9, 2021 49:49


In COVID-19 clinical update #83, Daniel Griffin discusses upcoming FDA discussions on vaccines, strategies to prevent transmission at youth camps, outbreaks at summer camps, impact of vaccination on transmission, AZD7442 request for EUA filed, EUA issued for home antigen test, phase 3 data on AZD1222 vaccine, 6 month effectiveness of Pfizer/BioNTech vaccine, estimates of durability of immunity against reinfection, Molnupiravir interim results, optimal time for monoclonal antibody infusion, IVIG plus Infliximab for MIS-C, and effect of vaccination on long COVID. Hosts: Daniel Griffin and Vincent Racaniello Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Preventing transmission at camps (MMWR) Outbreaks at summer camps (MMWR) Impact of vaccination on transmission (medRxiv) AZD7442 request for FDA EUA (AstraZeneca) FDA EUA for home antigen test (FDA) Phase 3 results AZD1222 vaccine (NEJM) 6 month effectiveness BNT1`62b2 vaccine (Lancet) Durability of immunity vs reinfection (Lancet) Molnupiravir interim results (Merck) Optimal time for mAb therapy (Inf Dis Advisor) IVIG plus Infliximab for MIS-C (Pediatrics) Effect of vaccination on long COVID (Lancet preprint) Letters read on TWiV 814 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Gut podcast
CLARITY IBD: Anti-SARS-CoV-2 antibody and vaccination responses in patients treated with infliximab

Gut podcast

Play Episode Listen Later Apr 23, 2021 19:32


Dr Philip Smith, Digital and Education Editor of Gut and Consultant Gastroenterologist at the Royal Liverpool Hospital, interviews Dr Tariq Ahmad and Dr Nick Kennedy, both from the Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, UK. This special Gut podcast is focused on ‘Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab’ which is published in paper copy in Gut in May 2021 and the recently published paper ‘Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines’. Acknowledgements: The CLARITY IBD team would like to thank the CLARITY IBD team in Exeter, all of the 92 CLARITY IBD sites and over 7000 participants in the study. We are grateful to support from the NIHR CRN, Crohn's & Colitis UK and our funders. The related links: https://gut.bmj.com/content/early/2021/04/25/gutjnl-2021-324789 https://gut.bmj.com/content/70/5/865

BMJ's Coronavirus (COVID-19) playlist
CLARITY IBD: Anti-SARS-CoV-2 antibody and vaccination responses in patients treated with infliximab

BMJ's Coronavirus (COVID-19) playlist

Play Episode Listen Later Apr 23, 2021 19:32


Dr Philip Smith, Digital and Education Editor of Gut and Consultant Gastroenterologist at the Royal Liverpool Hospital, interviews Dr Tariq Ahmad and Dr Nick Kennedy, both from the Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, UK. This special Gut podcast is focused on ‘Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab' which is published in paper copy in Gut in May 2021 and the recently published paper ‘Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines'. Acknowledgements: The CLARITY IBD team would like to thank the CLARITY IBD team in Exeter, all of the 92 CLARITY IBD sites and over 7000 participants in the study. We are grateful to support from the NIHR CRN, Crohn's & Colitis UK and our funders. The related links: https://gut.bmj.com/content/early/2021/04/25/gutjnl-2021-324789 https://gut.bmj.com/content/70/5/865

It Takes Guts
S1Ep#3 - Jake's Story

It Takes Guts

Play Episode Listen Later Apr 19, 2021 61:44


In this episode Jake shares his IBD story and how his Crohn's diagnosis came about. This is a very raw and honest episode from Jake and as you will hear, he tells the uncut, unedited version. As a stand up comedian, Jake likes to find the funny side of his battle and you can see this on the Crohn's & Colitis charity page on the socials where he has been dressing up in fancy dress to attend his Infliximab infusion appointments. He's a true fighter. Find us on Instagram @ittakesgutspod Darren - @darrendoesjokes Christine - @the.bright.sideee Jake - @jakesteerscomedy

First Past the Post
Infliximab

First Past the Post

Play Episode Listen Later Feb 1, 2021 0:37


This episode covers infliximab!

The European Heart Journal – Case Reports Podcast
Dr Aswin Babu discusses 'Refractory constrictive pericarditis caused by an immune checkpoint inhibitor properly managed with infliximab: a case report' by Shohei Moriyama et al.

The European Heart Journal – Case Reports Podcast

Play Episode Listen Later Feb 1, 2021 10:11


In this episode, Dr Aswin Babu discusses key points from a recent case report published in EHJ – Case Reports.

Rio Bravo qWeek
Episode 21 - The Sick Duel: UC vs CD

Rio Bravo qWeek

Play Episode Listen Later Jul 30, 2020 18:19


The following episode is a didactic activity. Our goal is teaching family medicine residents about these diseases and prepare them to treat their patients. We hope those who are suffering from these diseases do not find this activity offensive. May you find an appropriate treatment and get better. Consult your own family medicine doctor to learn more. Similar but different, sound-alike but opposite, analogous but heterologous. Welcome to the Sick Duel, an epic comparison between two merciless opponents. Our rivals today are: Ulcerative Colitis, “I will show you how to ulcer”; and Crohn’s Disease, “I will drill your guts”. Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the GI tract. Ulcerative colitis and Crohn's disease are the main representatives of these disease. Today we will hear why they don’t get along and hopefully we’ll come to a good end. Here we have our first guest Arreaza: Who are you?UC: Ulcerative Colitis is the name, and inflammation is the game. They say to save the best for last, so I tend to stick to the rectum and distal colon.  I like to come and go (no pun intended), creating episodic, mucinous diarrhea for my victims that is usually bloody.  I can be mild or severe, depending on the extent of mucosal involvement and level of inflammation.  Arreaza: How do you manifest?UC: I like to make my victims as uncomfortable as possible, creating urgency, pain, and constipation, while leaving them with a feeling like they aren’t “done” yet (aka tenesmus).  Arreaza: I thought you said diarrhea, and now you mention constipation?UC: Yes, I may cause periods of constipation when I am merciful, but diarrhea when I am cruel. Regardless of the thickness of the stools, I give them a mucinous and usually bloody discharge, sometimes leading to anemia. I like to attack extra intestinal organs such as the skin (causing pyoderma gangrenosum and erythema nodosum), the eyes (causing uveitis), and the joints (causing arthritis). Yes, my aunt Cronh’s can do some things right!6. Arreaza: I’ve heard Ms Cronh’s is really mean. Where else do you go?UC: Occasionally, I’ll make my way to the liver and cause primary sclerosing cholangitis.  My primary goal though is creating crypt abscesses and ulcerations.  If I’m lucky enough, I can progress to a fulminant, toxic level creating systemic symptoms and abdominal distention.  I hope to eventually make my way out of the GI tract through perforation (who doesn’t like a pinata?). Arreaza: I can see why your last name, colitis, can be deceiving, you can actually get out of the colon… Who are more likely to be your victims?UC: I like to run in families. I prefer people who eat lots of fatty foods (Standard American Diet anyone?), high omega-6:omega-3 ratio, with history of previous bouts of gastroenteritis.  HLA autoimmune association, especially HLA-DR2. Even though smoking is a risk in many diseases, in my case, cigarette smoking may protect my victims from my attack, but if they smoked before and quit, I have a better chance to show up.Arreaza: How do you get caught?UC:  My victims tend to have chronic diarrhea for at least four weeks.  Because I am an inflammatory villain, many inflammatory tests can be non-specific such as ESR, fecal calprotectin/lactoferrin, etc.  Therefore, if you want me, you’re gonna have to come and get me.  Beware of your hospitalized patients, as a colonoscopy will greatly increase my ability to form a toxic megacolon and perforation!  Flexible sigmoidoscopy is recommended and will show you crypt abscesses, friable mucosa, decreased vascular markings and my continuous pattern of inflammation, yes, continuous, you gotta be consistent, unlike Ms. Crohn’s who likes skipping like a loser! How do you get eliminated? (What humans call treatment)UC:  When my victims aren’t suffering as much as I’d like, those doctors first like to throw anti-inflammatories at me (such as mesalamine).  If that doesn’t work, they’ll throw in some steroids. However, if I’ve really done my job, then treatment usually starts with some immunomodulators (Azathioprine, Infliximab, etc.) followed by steroids with the goal of inducing remission.  If all else fails, they’re just gonna have to remove me along with my victims’ colon, so surgeons are their last resource to get rid of me!Arreaza: What determines how bad you will be? (Prognosis)UC:  Several factors influence my prognosis such as age of onset. Victims older than 50 have more chances to have a steroid-free remission. I hate smoking! Smoke does not let me grow, so when a patient quit smoking I can be more aggressive. When the intestinal mucosa heals early in the disease, my victims have a better prognosis. My chance of extension is higher in more distal areas, for example, patients with proctitis have 50% chance of extension. If my victims had an appendectomy before age 20, they have less chances of hospitalization and colectomy. With treatment, my victims may experience long periods of symptomatic remission along with intermittent exacerbations, although a small percentage may continue to have chronic symptoms and are less likely to achieve remission. The latter may require lifelong therapy or possible colectomy (Physicians 1, Me 0).  Ulcerative colitis, you really know how to ulcer. Now we invite our next guest.Arreaza: Who are you?Crohn’s: Hi everyone, I’m Crohn's disease and unlike UC I don’t only affect the colon but I can affect any area of the GI tract from the mouth to the anus. Not only can I affect the whole GI tract but also, I can affect all the layers of the GI wall. Doctors like to call that “transmural inflammation”. Also, I can be sneaky, showing symptoms for a long time before diagnosis or I can happen all of a sudden and be diagnosed acutely.How do you manifest?Crohn’s: There are a few ways I can show up, but mainly I cause crampy abdominal pain, diarrhea either bloody or non-bloody, fatigue and weight loss. If I’m only located in the distal ileum, then I will give you right lower quadrant pain. Since I have transmural inflammatory forces, I can cause formation of sinus tracts that can result in abscesses or phlegmons. Phlegmon is a word that a lot of radiologist like to use and it pretty much means the formation of an abscess but not yet an abscess, so it can’t be drained but can treated with antibiotics. Sinus tracts can end up in microperforations or even fistulas. A fistula is when a connection forms between two tissues that are not supposed to be connected and, yes, it kinda sucks for my victims, especially when this connection happens between the bladder and the colon and you end up with urine mixed with feces coming out of either end. Ohh and if it connects from the GI tract to the skin then you may have continuous leakage of feces. WOW! I’m terrible, I know…Arreaza: You are really mean!On a lighter note, sometimes I cause no symptoms… at least not for a while until I make your GI tract so narrow that you defecate less frequently and end up having pain, and eventually your tract becomes obstructed. Man, yeah this pretty much sucks too. My bad!Arreaza: I know you have more, tell us more about you.I almost want to stop telling you anything else but there are a few more things. For example, I could give you aphthous ulcers in the mouth, pain in the esophagus or difficulty swallowing, abdominal pain, watery diarrhea, steatorrhea or oily diarrhea. OMG there's a bit more; last but not least some people may also have: arthritis of large joints, skin disorders like erythema nodosum or pyoderma gangrenosum and very few will experience hepatobiliary involvement such as primary sclerosing cholangitis or even eye issues like uveitis, iritis and episcleritis… among others.Arreaza: You and your nephew UC really like going out of the GI tract, but I think you are more adventurous. Who are more likely to be your victims?Crohn’s: Unlike UC, I actually like smokers, smoke helps me thrive! Those who have antibiotic exposure are at risk, also those with increased fats in diet, and maybe a little increased risk with NSAIDs and OCPs. Appendectomy may be a result of hidden CD vs a risk factor. If you want to avoid CD, high fiber and a Vit D supplementation are associated with decrease risk of CD. If you were breastfed, you have lower risk to get CD.How are you caught? (diagnosis)Crohn’s: You can usually suspect CD when there is a combination of suggestive features, such as RLQ pain, chronic intermittent diarrhea, fatigue and weight loss. Laboratory tests can show anemia, vitamin B12 and Vitamin D deficiency (malabsorption). Diagnosis is made certain via imaging, endoscopy and histological findings that show the aforementioned “transmural inflammation”. I think everyone will remember this “transmural inflammation” sign.How can your victims fight you? (treatment)Crohn’s: The treatment will be different depending on where I’am at, how bad I am and whether you want to stop me or keep me quiet. If I’m mild, then you can use oral 5-aminosalicylates like sulfasalazine or mesalamine, glucocorticoids, immunomodulators such as methotrexate or azathioprine; and biologic therapies such as infliximab, adalilumab, etc. Yep, these are some pretty tough names to combat a tough disease like me!If I am moderate to severe then you’ll need a combo of meds: anti-TNF like infliximab plus an immunomodulator. The GI doctors are my archenemies! What determines how bad you will be? (prognosis)Crohn’s: It can vary, most of the patients will experience a continuous progression while about 20% of patients can experience remission after initial presentation. Risk factors for progressive disease are smoking, age

GI Insights
Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

GI Insights

Play Episode Listen Later Jul 22, 2020


Host: Abdullah Abdussalam, MD Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Diana M Negoescu, Eva A Enns, PhD, Brooke Swanhorst, Bonnie Baumgartner, James P Campbell, Mark T Osterman, MD, Konstantinos Papamichael, PhD, Adam S Cheifetz, MD, Byron P Vaughn, MD Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX. Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.

AudioAbstracts
Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

AudioAbstracts

Play Episode Listen Later Jul 22, 2020


Host: Abdullah Abdussalam, MD Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Diana M Negoescu, Eva A Enns, PhD, Brooke Swanhorst, Bonnie Baumgartner, James P Campbell, Mark T Osterman, MD, Konstantinos Papamichael, PhD, Adam S Cheifetz, MD, Byron P Vaughn, MD Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX. Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.

Crohn’s & Colitis Foundation Perspectives
Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

Crohn’s & Colitis Foundation Perspectives

Play Episode Listen Later Jul 22, 2020


Host: Abdullah Abdussalam, MD Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Diana M Negoescu, Eva A Enns, PhD, Brooke Swanhorst, Bonnie Baumgartner, James P Campbell, Mark T Osterman, MD, Konstantinos Papamichael, PhD, Adam S Cheifetz, MD, Byron P Vaughn, MD Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX. Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.

AudioAbstracts
Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

AudioAbstracts

Play Episode Listen Later Jul 22, 2020


Host: Abdullah Abdussalam, MD Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Diana M Negoescu, Eva A Enns, PhD, Brooke Swanhorst, Bonnie Baumgartner, James P Campbell, Mark T Osterman, MD, Konstantinos Papamichael, PhD, Adam S Cheifetz, MD, Byron P Vaughn, MD Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX. Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.

GI Insights
Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

GI Insights

Play Episode Listen Later Jul 22, 2020


Host: Abdullah Abdussalam, MD Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Diana M Negoescu, Eva A Enns, PhD, Brooke Swanhorst, Bonnie Baumgartner, James P Campbell, Mark T Osterman, MD, Konstantinos Papamichael, PhD, Adam S Cheifetz, MD, Byron P Vaughn, MD Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX. Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.

Crohn’s & Colitis Foundation Perspectives
Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

Crohn’s & Colitis Foundation Perspectives

Play Episode Listen Later Jul 22, 2020


Host: Abdullah Abdussalam, MD Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Diana M Negoescu, Eva A Enns, PhD, Brooke Swanhorst, Bonnie Baumgartner, James P Campbell, Mark T Osterman, MD, Konstantinos Papamichael, PhD, Adam S Cheifetz, MD, Byron P Vaughn, MD Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX. Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.

The Clinical Research Circle
Infliximab, Anticoagulation, and antibodies in COVID19 Clinical Trials

The Clinical Research Circle

Play Episode Listen Later Jul 9, 2020 29:15


http://www.clinicalscoop.comText (949) 415-6256

RCGP Podcast
47: Fertility, pregnancy and IBD - a conversation with Dr Aarthi Mohan

RCGP Podcast

Play Episode Listen Later Feb 12, 2020 22:43


Does Inflammatory Bowel Disease (IBD) affect fertility?  Do people with IBD have more adverse outcomes in pregnancy?   Are biologics, for example, Infliximab and Adalimumab, safe to use in pregnancy? How do you treat a flare in pregnancy?  If you work in primary care and you want to know the answer to these questions and lots more, this is the podcast for you.    In this episode, GP, Dr Charles Andrews, discusses contraception, pregnancy and breastfeeding in people with IBD with Dr Aarthi Mohan, an experienced Obstetrician at St Michael's hospital in Bristol, who runs a quaternary level service for pregnant women with concurrent medical conditions.  She shares a wealth of experience with Dr Andrews about all aspects of fertility and pregnancy in patients with IBD.   According to a study by Tavernier et al., infertility rates in people with IBD is mainly due to voluntary childlessness rather than infertility contributed to by the disease itself (Tavernier et al. Systematic review: fertility in non-surgically treated inflammatory bowel disease, Alimentary pharmacology and therapeutics, Oct. 2013).  This voluntary childlessness is significantly higher than those not affected by IBD (14-18% vs. 6%) and this is mainly due to incorrect beliefs about how their disease may affect their fertility and outcomes in pregnancy. Therefore having a good knowledge of these issues is important for both primary care and secondary care clinicians looking after patients with IBD so that these patients can have accurate advice when planning their family.   On this podcast, they discuss: Contraception The effects of IBD on fertility  What to do with various medications in pregnancy How should we approach flare management in these patients IBD and venous thromboembolism risk in pregnancy Folic acid use Mode of delivery in those with IBD The pregnancy pathway for those with IBD IBD and breastfeeding Post-natal depression in patients with IBD. You can access the IBD toolkit (https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/inflammatory-bowel-disease-toolkit.aspx) on the RCGP website. The Crohns and Colitis UK website has an excellent patients' guide to IBD and pregnancy (https://www.crohnsandcolitis.org.uk/about-inflammatory-bowel-disease/publications/pregnancy-ibd) ,    NB. This episode was recorded in a busy maternity hospital, so there is some background noises because of this. 

BrainWaves: A Neurology Podcast
#153 Neurosarcoidosis: The 21st century great mimicker

BrainWaves: A Neurology Podcast

Play Episode Listen Later Dec 12, 2019 34:22


In the TV show, HOUSE, it's either lupus or its sarcoidosis. Only, it's never sarcoidosis. That's because sarcoidosis is such a heterogeneous condition and can affect practically any age group. In some patients, this idiopathic inflammatory disorder can also involve the nervous system. Also causing a variety of signs and symptoms ranging from mild headache to a proximal myopathy or even a CNS vasculitis. This week on the BrainWaves podcast, Dr. Jesse Thon reflects on the literature and shares his experience managing patients with this troubling condition. Produced by Jesse Thon and James E. Siegler. Music courtesy of Steve Combs, Lovira, and Yakov Goldman. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Petereit HF, Reske D, Tumani H, Jarius S, Markus Leweke F, Woitalla D, Pfister HW and Rubbert A. Soluble CSF interleukin 2 receptor as indicator of neurosarcoidosis. Journal of neurology. 2010;257:1855-63. Agnihotri SP, Singhal T, Stern BJ and Cho TA. Neurosarcoidosis. Semin Neurol. 2014;34:386-94. Bitoun S, Bouvry D, Borie R, Mahevas M, Sacre K, Haroche J, Psimaras D, Pottier C, Mathian A, Hie M, Boutin DL, Papo T, Godeau B, Valeyre D, Nunes H, Amoura Z and Cohen Aubart F. Treatment of neurosarcoidosis: A comparative study of methotrexate and mycophenolate mofetil. Neurology. 2016;87:2517-2521. Gelfand JM, Bradshaw MJ, Stern BJ, Clifford DB, Wang Y, Cho TA, Koth LL, Hauser SL, Dierkhising J, Vu N, Sriram S, Moses H, Bagnato F, Kaufmann JA, Ammah DJ, Yohannes TH, Hamblin MJ, Venna N, Green AJ and Pawate S. Infliximab for the treatment of CNS sarcoidosis: A multi-institutional series. Neurology. 2017;89:2092-2100. Jolliffe EA, Keegan BM and Flanagan EP. Trident sign trumps Aquaporin-4-IgG ELISA in diagnostic value in a case of longitudinally extensive transverse myelitis. Mult Scler Relat Disord. 2018;23:7-8. Wallaert B, Ramon P, Fournier EC, Hatron PY, Muir JF, Tonnel AB and Voisin C. High-dose methylprednisolone pulse therapy in sarcoidosis. Eur J Respir Dis. 1986;68:256-62. Agbogu BN, Stern BJ, Sewell C and Yang G. Therapeutic considerations in patients with refractory neurosarcoidosis. Archives of neurology. 1995;52:875-9. Baughman RP and Lower EE. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2001;18:70-4. Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, du Bois R, Albera C, Brutsche M, Davis G, Donohue JF, Muller-Quernheim J, Schlenker-Herceg R, Flavin S, Lo KH, Oemar B, Barnathan ES and Sarcoidosis I. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med. 2006;174:795-802. Rossman MD, Newman LS, Baughman RP, Teirstein A, Weinberger SE, Miller W, Jr. and Sands BE. A double-blinded, randomized, placebo-controlled trial of infliximab in subjects with active pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2006;23:201-8.

Not So Different: a Podcast from The Center for Biosimilars
29: Celltrion Breaks New Ground With a Subcutaneous Biosimilar Infliximab

Not So Different: a Podcast from The Center for Biosimilars

Play Episode Listen Later Dec 8, 2019 10:03


Last month, the European Commission authorized a subcutaneously administered formulation of biosimilar infliximab CT-P13 for the treatment of rheumatoid arthritis. When the drug launches in the European Union, it will be first infliximab to be available in a subcutaneous formulation. This week on the podcast, we’re speaking about this new product with Mike An, head of the sales and operations division at Celltrion Healthcare. 

Tukua
Dactilítis

Tukua

Play Episode Listen Later Oct 26, 2019 17:03


¡Gracias por escuchar! En este episodio repaso algunos conceptos relevantes sobre la dactilítis, una manifestación común en espondiloartritis. Les pido amablemente que califiquen este episodio en iTunes, o dejen sus comentarios en esta página. El podcast se encuentra disponible también en Spotify y a través de la aplicación gestora de podcasts de su elección.Abajo enlisto referencias útiles, algunas mencionadas en el episodio: Olivieri, I., Scarano, E., Padula, A., Giasi, V. & Priolo, F. Dactylitis, a term for different digit diseases. Scand. J. Rheumatol. 35, 333–340 (2006). Gladman, D. D., Ziouzina, O., Thavaneswaran, A. & Chandran, V. Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. J. Rheumatol. 40, 1357–1359 (2013). Ritchlin, C. T., Colbert, R. A. & Gladman, D. D. Psoriatic arthritis. N. Engl. J. Med. 376, 957–970 (2017). Rothschild, B. M., Pingitore, C. & Eaton, M. Dactylitis: implications for clinical practice. Semin. Arthritis Rheum. 28, 41–47 (1998). Taylor, W. J. et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 54, 2665–2673 (2006). Rudwaleit, M. et al. The Assessment of Spondyloarthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann. Rheum. Dis. 70, 25–31 (2011). Brockbank, J. E., Stein, M., Schentag, C. T. & Gladman, D. D. Dactylitis in psoriatic arthritis: a marker for disease severity? Ann. Rheum. Dis. 64, 188–190 (2005). Kavanaugh, A., Helliwell, P. & Ritchlin, C. T. Psoriatic arthritis and burden of disease: patient perspectives from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Rheumatol. Ther. 3, 91–102 (2016). Kaeley, G. S., Eder, L., Aydin, S. Z., Gutierrez, M. & Bakewell, C. Dactylitis: a hallmark of psoriatic arthritis. Semin. Arthritis Rheum. 48, 263–273 (2018). McGonagle, D., Conaghan Philip, G. & Emery, P. Psoriatic arthritis: a unified concept twenty years on. Arthritis Rheum. 42, 1080–1086 (2001). Tinazzi, I. et al. ‘Deep Koebner’ phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. Ann. Rheum. Dis. 77, 922 (2018). Pattison, E., Harrison, B. J., Griffiths, C. E., Silman, A. J. & Bruce, I. N. Environmental risk factors for the development of psoriatic arthritis: results from a case-control study. Ann. Rheum. Dis. 67, 672–676 (2008). Ng, J., Tan, A. L. & McGonagle, D. Unifocal psoriatic arthritis development in identical twins following site specific injury: evidence supporting biomechanical triggering events in genetically susceptible hosts. Ann. Rheum. Dis. 74, 948–949 (2015). Jacques, P. et al. Proof of concept: enthesitis and new bone formation in spondyloarthritis are driven by mechanical strain and stromal cells. Ann. Rheum. Dis. 73, 437–445 (2014). Jacques, P. & McGonagle, D. The role of mechanical stress in the pathogenesis of spondyloarthritis and how to combat it. Best Pract. Res. Clin. Rheumatol. 28, 703–710 (2014). Thorarensen, S. M. et al. Physical trauma recorded in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis. Ann. Rheum. Dis. 76, 521–525 (2017). Wilkins, R. A., Siddle, H. J., Redmond, A. C. & Helliwell, P. S. Plantar forefoot pressures in psoriatic arthritis-related dactylitis: an exploratory study. Clin. Rheumatol. 35, 2333–2338 (2016). Tan, A. L. & McGonagle, D. The need for biological outcomes for biological drugs in psoriatic arthritis. J. Rheumatol. 43, 3–6 (2016). Mumtaz, A. et al. Development of a preliminary composite disease activity index in psoriatic arthritis. Ann. Rheum. Dis. 70, 272–277 (2011). Helliwell, P. S. et al. The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann. Rheum. Dis. 72, 986–991 (2013). Ramiro, S., Smolen, J. S., Landewe, R., van der Heijde, D. & Gossec, L. How are enthesitis, dactylitis and nail involvement measured and reported in recent clinical trials of psoriatic arthritis? A systematic literature review. Ann. Rheum. Dis. 77, 782–783 (2017). Salvarani, C. et al. A comparison of cyclosporine, sulfasalazine, and symptomatic therapy in the treatment of psoriatic arthritis. J. Rheumatol. 28, 2274–2282 (2001). Antoni, C. E. et al. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum. 52, 1227–1236 (2005). Clegg, D. O. et al. Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum. 39, 2013–2020 (1996). Helliwell, P. S. et al. Development of an assessment tool for dactylitis in patients with psoriatic arthritis. J. Rheumatol. 32, 1745–1750 (2005). Healy, P. J. & Helliwell, P. S. Measuring dactylitis in clinical trials: which is the best instrument to use? J. Rheumatol. 34, 1302–1306 (2007). Chandran, V. et al. International multicenter psoriasis and psoriatic arthritis reliability trial for the assessment of skin, joints, nails, and dactylitis. Arthritis Rheum. 61, 1235–1242 (2009).Mease, P. et al. Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a phase 3 double-blind randomised placebo-controlled study (RAPID-PsA). Ann. Rheum. Dis. 73, 48–55 (2014). Fournie, B. et al. Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis. Joint Bone Spine 73, 527–531 (2006). Benjamin, M. & McGonagle, D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J. Anat. 199, 503–526 (2001). Kane, D., Greaney, T., Bresnihan, B., Gibney, R. & FitzGerald, O. Ultrasonography in the diagnosis and management of psoriatic dactylitis. J. Rheumatol. 26, 1746–1751 (1999). Tinazzi, I. et al. Comprehensive evaluation of finger flexor tendon entheseal soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis. Clin. Exp. Rheumatol. 36, 785–790 (2018). McGonagle, D., Gibbon, W. & Emery, P. Classification of inflammatory arthritis by enthesitis. Lancet 352, 1137–1140 (1998). Olivieri, I. et al. Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum. 39, 1524–1528 (1996).Olivieri, I. et al. Toe dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging. J. Rheumatol. 24, 926–930 (1997). Olivieri, I. et al. Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis. No evidence of entheseal involvement of the flexor digitorum tendons. Arthritis Rheum. 46, 2964–2967 (2002). Healy, P. J., Groves, C., Chandramohan, M. & Helliwell, P. S. MRI changes in psoriatic dactylitis extent of pathology, relationship to tenderness and correlation with clinical indices. Rheumatology 47, 92–95 (2008). Tan, A. L. et al. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann. Rheum. Dis. 74, 185–189 (2015). FitzGerald, O., Haroon, M., Giles, J. T. & Winchester, R. Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype. Arthritis Res. Ther. 17, 115 (2015). McHugh, K. & Bowness, P. The link between HLA-B27 and SpA—new ideas on an old problem. Rheumatology 51, 1529–1539 (2012). Ritchlin, C. T. et al. Treatment recommendations for psoriatic arthritis. Ann. Rheum. Dis. 68, 1387–1394 (2009). Coates, L. C. et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheum. 68, 1060–1071 (2016). Gossec, L. et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann. Rheum. Dis. 75, 499–510 (2016). Coates, L. & Helliwell, P. S. Methotrexate efficacy in the Tight Control in Psoriatic Arthritis study. J. Rheum. 43, 356–361 (2016). Rose, S., Toloza, S., Bautista-Molano, W. & Helliwell, P. S. Comprehensive treatment of dactylitis in psoriatic arthritis. J. Rheumatol. 41, 2295–2300 (2014). Kavanaugh, A. et al. Efficacy and safety of ustekinumab in psoriatic arthritis patients with peripheral arthritis and physician-reported spondylitis: post-hoc analyses from two phase III, multicentre, double-blind, placebo-controlled studies (PSUMMIT-1/PSUMMIT-2). Ann. Rheum. Dis. 75, 1984–1988 (2016). Mease, P. et al. Tofacitinib or adalimumab versus placebo for psoriatic arthritis. N. Engl. J. Med. 377, 1537–1550 (2017). Kavanaugh, A. et al. Golimumab in psoriatic arthritis: one-year clinical efficacy, radiographic, and safety results from a phase III, randomized, placebo-controlled trial. Arthritis Rheum. 64, 2504–2517 (2012). Kavanaugh, A. & Mease, P. Treatment of psoriatic arthritis with tumor necrosis factor inhibitors: longer-term outcomes including enthesitis and dactylitis with golimumab treatment in the Longterm Extension of a Randomized, Placebo-controlled Study (GO-REVEAL). J. Rheumatol. Suppl. 89, 90–93 (2012). Antoni, C. E. et al. Two-year efficacy and safety of infliximab treatment in patients with active psoriatic arthritis: findings of the Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT). J. Rheumatol. 35, 869–876 (2008). Kavanaugh, A. et al. Infliximab maintains a high degree of clinical response in patients with active psoriatic arthritis through 1 year of treatment: results from the IMPACT 2 trial. Ann. Rheum. Dis. 66, 498–505 (2007). Baranauskaite, A. et al. Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study. Ann. Rheum. Dis. 71, 541–548 (2012). Carron, P. et al. Scintigraphic detection of TNF-driven inflammation by radiolabelled certolizumab pegol in patients with rheumatoid arthritis and spondyloarthritis. RMD Open 2, e000265 (2016). Nash, P. et al. Efficacy and safety of secukinumab administration by autoinjector in patients with psoriatic arthritis: results from a randomized, placebo-controlled trial (FUTURE 3). Arthritis Res. Ther. 20, 47 (2018). Mease, P. et al. Secukinumab improves active psoriatic arthritis symptoms and inhibits radiographic progression: primary results from the randomised, double-blind, phase III FUTURE 5 study. Ann. Rheum. Dis. 77, 890–897 (2018). Mease, P. J. et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann. Rheum. Dis. 76, 79–87 (2017). Wells, A. F. et al. Apremilast monotherapy in DMARD-naive psoriatic arthritis patients: results of the randomized, placebo-controlled PALACE 4 trial. Rheumatology 57, 1253–1263 (2018). Gladman, D. et al. Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors. N. Engl. J. Med. 377, 1525–1536 (2017). Mease, P. J. et al. Efficacy and safety of abatacept, a T cell modulator, in a randomised, double-blind, placebo-controlled, phase III study in psoriatic arthritis. Ann. Rheum. Dis. 76, 1550–1558 (2017). Genovese Mark, C. et al. Apremilast in patients with active rheumatoid arthritis: a phase II, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 67, 1703–1710 (2015). Smolen, J. S. et al. A randomised phase II study evaluating the efficacy and safety of subcutaneously administered ustekinumab and guselkumab in patients with active rheumatoid arthritis despite treatment with methotrexate. Ann. Rheum. Dis. 76, 831–839 (2017). Kavanaugh, A. et al. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann. Rheum. Dis. 73, 1020–1026 (2014). Kunwar, S., Dahal, K. & Sharma, S. Anti-IL-17 therapy in treatment of rheumatoid arthritis: a systematic literature review and meta-analysis of randomized controlled trials. Rheumatol. Int. 36, 1065–1075 (2016). da Silva Junior, G. B., Daher Ede, F. & da Rocha, F. A. Osteoarticular involvement in sickle cell disease. Rev. Bras. Hematol. Hemoter. 34, 156–164 (2012). Braum, L. S. et al. Characterisation of hand small joints arthropathy using high-resolution MRI — limited discrimination between osteoarthritis and psoriatic arthritis. Eur. Radiol. 23, 1686–1693 (2013). Tan, A. L., Grainger, A. J., Tanner, S. F., Emery, P. & McGonagle, D. A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthritis Rheum. 54, 1328–1333 (2006). Tuttle, K. S., Vargas, S. O., Callahan, M. J., Bae, D. S. & Nigrovic, P. A. Enthesitis as a component of dactylitis in psoriatic juvenile idiopathic arthritis: histology of an established clinical entity. Pediatr. Rheumatol. Online J. 13, 7 (2015). Nash, P. et al. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet 389, 2317–2327 (2017).Jeong, H. et al. Spondyloarthritis features in zymosan-induced SKG mice. Joint Bone Spine 85, 583–591 (2018). 

Pharma Intelligence Podcasts
Celltrion’s Subcutaneous Infliximab And The Future Of Biosimilars

Pharma Intelligence Podcasts

Play Episode Listen Later Oct 11, 2019 20:05


Celltrion’s Subcutaneous Infliximab And The Future Of Biosimilars by Informa

The Psych Review
S2E7 - Infliximab, Antipsychotic Duration, and Dimensional Diagnosis

The Psych Review

Play Episode Listen Later Sep 8, 2019 31:04


The seventh episode of season two of The Psych Review finds Dave looking internationally (again) at the use of infliximab in the treatment of bipolar depression, see's Shakira explore how we should talk about duration of antipsychotic treatment with patients with schizophrenia, and allows Mazz to have a rant about whether personality disorder diagnosis should be typological or dimensional. The articles covered in this month's episode are:- Dave: McIntyre, R. S., Subramaniapillai, M., Lee, Y., Pan, Z., Carmona, N. E., Shekotikhina, M., ... & Miller, S. (2019). Efficacy of Adjunctive Infliximab vs Placebo in the Treatment of Adults With Bipolar I/II Depression: A Randomized Clinical Trial. JAMA psychiatry.- Shakira: Bendall, S. (2019). Costs versus benefits and impact on life goals should be part of communication around anti-psychotic treatment duration in schizophrenia. Australian & New Zealand Journal of Psychiatry, 53(8), 811–812. https://doi.org/10.1177/0004867419860905- Mazz: Irwin, L. and Mahli, S. G. (2019). Borderline personality disorder and ICD-11: A chance for change. Australian and New Zealand Journal of Psychiatry, 53(7) pages 698-700.The Psych Review was brought to you by Call to Mind, a new telepsychiatry service that you can learn more about at www.calltomind.com.au. The original music in our podcast was provided by the very talented John Badgery, and our logo was designed by the creative genius of Naz.

Crohn’s & Colitis Foundation Perspectives
Assessing the Correlation Between Perianal Fistula Healing & Trough Levels of Infliximab in Children with IBD

Crohn’s & Colitis Foundation Perspectives

Play Episode Listen Later Jun 19, 2019


Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area under the receiver operating characteristic curve (AUROC) was calculated to determine the best cutoff to predict fistula ...

GI Insights
Assessing the Correlation Between Perianal Fistula Healing & Trough Levels of Infliximab in Children with IBD

GI Insights

Play Episode Listen Later Jun 19, 2019


Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area under the receiver operating characteristic curve (AUROC) was calculated to determine the best cutoff to predict fistula ...

AudioAbstracts
Assessing the Correlation Between Perianal Fistula Healing & Trough Levels of Infliximab in Children with IBD

AudioAbstracts

Play Episode Listen Later Jun 19, 2019


Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area under the receiver operating characteristic curve (AUROC) was calculated to determine the best cutoff to predict fistula ...

AudioAbstracts
Assessing the Correlation Between Perianal Fistula Healing & Trough Levels of Infliximab in Children with IBD

AudioAbstracts

Play Episode Listen Later Jun 18, 2019


Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area under the receiver operating characteristic curve (AUROC) was calculated to determine the best cutoff to predict fistula ...

Focus on Children's Health
Assessing the Correlation Between Perianal Fistula Healing & Trough Levels of Infliximab in Children with IBD

Focus on Children's Health

Play Episode Listen Later Jun 18, 2019


Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area under the receiver operating characteristic curve (AUROC) was calculated to determine the best cutoff to predict fistula ...

GI Insights
Assessing the Correlation Between Perianal Fistula Healing & Trough Levels of Infliximab in Children with IBD

GI Insights

Play Episode Listen Later Jun 18, 2019


Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area under the receiver operating characteristic curve (AUROC) was calculated to determine the best cutoff to predict fistula ...

Crohn’s & Colitis Foundation Perspectives
Assessing the Correlation Between Perianal Fistula Healing & Trough Levels of Infliximab in Children with IBD

Crohn’s & Colitis Foundation Perspectives

Play Episode Listen Later Jun 18, 2019


Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area under the receiver operating characteristic curve (AUROC) was calculated to determine the best cutoff to predict fistula ...

Rheuminations
Trials and Tribulations of Tumor Necrosis Factor, Part 2: Even More Necrosis

Rheuminations

Play Episode Listen Later Apr 17, 2019 47:43


This ripping yarn delves into the history of tumor necrosis factor in relation to rheumatoid arthritis with emphasis on the original studies that set the stage for the use of TNF inhibition in RA.  Intro :11 What we’ll cover here :16 Recap of Part 1 1:25 What I discovered when doing this episode 1:22 What this episode won’t address 2:40 Let the tale begin 3:12 A look at matrix metalloproteinases 3:32 A breakthrough in understanding RA 6:28 Two key players: Dr. Mark Feldman and Dr. Ravinder Maini 6:53 The first cytokine research conducted in RA: IL-1 8:00 The next cytokine: Tumor necrosis factor 11:16 What do we know about cytokine production within the joint? 14:33 IL-6 and TGF-beta 19:16 A bit about IL-10 23:57 *Visit Healio.com/rheum for daily news and updates* How do we choose which cytokines to block to make improvements in RA? 25:16 What about in vivo data? 29:45 The history of infliximab 34:00 Infliximab is approved for RA treatment 45:13 TNF in RA: from bedside, to bench then back to bedside 46:06 It’s important to recognize the researchers who discovered these pathways 46:18 Remember the scientists next time you prescribe a TNF inhibitor 47:05 Read the latest news and commentary on Healio.com/rheumatology and Follow us on Twitter @HealioRheum and @HRheuminations for updates 47:34 We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Brennan FM, et al. J Autoimmun. 1989;2 Suppl:177-186. Brennan FM, et al. Lancet. 1989;2:244-247. Butler MD, et al. Eur Cytokine Netw. 1995;6:225-230. Chu CQ, et al. Arthritis Rheum. 1991;34:1125-1132. Dayer JM, et al. J Exp Med. 1985;162:2163-2168. Di Giovine FS, et al. Ann Rheum Dis. 1988;47:768-772. Feldmann, M. Nat Rev Immunol. 2002;2:364-371. Feldmann M, Maini SR. Immunol Rev. 2008;223:7-19. Fontana A, et al. Rheumatol Int. 1982;2:49-53. Haworth C, et al. Eur J Immunol. 1991;21:2575-9. Houssiau FA, et al. Arthritis Rheum. 1988;31:784-8. Keffer J, et al. EMBO J. 1991;10:4025-4031. Kulkarni AB, Karlsson S. Am J Pathol. 1993;143:3-9. Kuruvilla AP, et al. PNAS. 1991;88:2918-2921. Maini RN, et al. Arthritis Rheum. 1998;41:1552-1563. Malaviya AN, Mehra NK. Indian J Med Res. 2018;148:263–278. McInnes IB, Schett G. Nat Rev Immunol. 2007;7:429-442. Mitchison NA, Medawar PB. Proc R Soc Lond [Biol]. 1964;https://doi.org/10.1098/rspb.1964.0093. Pettipher ER, et al. Proc Natl Acad Sci U S A. 1986;83:8749-8753. The Beautiful Cure: The Revolution in Immunology and What It Means for Your Health, University of Chicago Press, Chicago, 2018. Williams RO, et al. Proc Natl Acad Sci U S A. 1992;89:9784-9788. Xu WD, et al. J Clin Invest. 1989;83:876-882.

Purple Pen Podcast
PPP049 - Updates on IBD with Clarissa Rentsch

Purple Pen Podcast

Play Episode Listen Later Jun 16, 2018 31:20


Dan and Jane are joined by Clarissa Rentsch to discuss updates on Inflammatory Bowel Disease with Clarissa Rentsch. Clarissa is the Senior Pharmacist - Gastroenterology at Alfred Health, and discusses new therapy for IBD, the developing role for TDM in the management of this disease and her innovative clinic based role at The Alfred. We discuss: Commencing therapy with and monitoring purine analogues Infliximab - its expanding role in therapy, and the emerging field of TDM for biologicals Clarissa's innovative role in the clinics, including dose adjustment and monitoring.

GI Pearls Podcast
GI Pearls – May 2018 – Episode 22

GI Pearls Podcast

Play Episode Listen Later May 21, 2018 18:20


Show Notes for May 2018 – Episode 22  – Peptic ulcers, Infections in IBD, EOE, dyspepsia, Infliximab, Pancreatic cysts. etc. Email me – info@gipearls.com if you want to meet up at DDW  Effects of Gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials – Lancet Gastro… Continue reading GI Pearls – May 2018 – Episode 22

AudioAbstracts
Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance

AudioAbstracts

Play Episode Listen Later Jan 2, 2018


Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance. Liefferinckx C1, Minsart C, Toubeau JF, Cremer A, Amininejad L, Quertinmont E, Devière J, Gils A, van Gossum A, Franchimont D. BACKGROUND: Infliximab (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. METHODS: This 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. RESULTS: During 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 = ...

Crohn’s & Colitis Foundation Perspectives
Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance

Crohn’s & Colitis Foundation Perspectives

Play Episode Listen Later Jan 2, 2018


Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance. Liefferinckx C1, Minsart C, Toubeau JF, Cremer A, Amininejad L, Quertinmont E, Devière J, Gils A, van Gossum A, Franchimont D. BACKGROUND: Infliximab (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. METHODS: This 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. RESULTS: During 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 = ...

Crohn’s & Colitis Foundation Perspectives
Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance

Crohn’s & Colitis Foundation Perspectives

Play Episode Listen Later Jan 1, 2018


Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance. Liefferinckx C1, Minsart C, Toubeau JF, Cremer A, Amininejad L, Quertinmont E, Devière J, Gils A, van Gossum A, Franchimont D. BACKGROUND: Infliximab (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. METHODS: This 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. RESULTS: During 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 = ...

AudioAbstracts
Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance

AudioAbstracts

Play Episode Listen Later Jan 1, 2018


Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance. Liefferinckx C1, Minsart C, Toubeau JF, Cremer A, Amininejad L, Quertinmont E, Devière J, Gils A, van Gossum A, Franchimont D. BACKGROUND: Infliximab (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. METHODS: This 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. RESULTS: During 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 = ...

Neurology® Podcast
November 14 2017 Issue

Neurology® Podcast

Play Episode Listen Later Nov 13, 2017 25:42


Show description/summary:1) Infliximab for the treatment of central nervous system sarcoidosis: A multi-institutional series2) What’s Trending: Sonic traumatic brain injuryThis podcast begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the November 14, 2017 issue of Neurology. In the first segment, Dr. Stacey Clardy talks with Dr. Siddharama Pawate and Dr. Jeff Gelfand about their paper on infliximab for treatment of central nervous system sarcoidosis. In the second part of the podcast, Dr. Alex Menze focuses his interview with Dr. Jeffrey Kim on the recent speculation around sonic traumatic brain injury.DISCLOSURES: Dr. Gelfand has served on scientific advisory boards for Genentech; has received compensation for consulting with Genentech; has received research support from Quest Diagnostics, Genentech, MedDay, and NIH National Center for Advancing Translational Sciences (KL2TR000143); and has received compensation for serving as expert witness in medical-legal consulting. Dr. Pawate has served on scientific advisory board for Biogen, and has received research support from Biogen.Dr. Clardy has received research support from Western Institute for Biomedical Research (WIBR).All other participants report no disclosures.

Clinical Gastroenterology & Hepatology
Withdrawal of Immunomodulators After Co-treatment Does Not Reduce Trough Level of Infliximab in Crohn's Disease Patients

Clinical Gastroenterology & Hepatology

Play Episode Listen Later Apr 2, 2015 14:19


A study in the March 2015 issue of CGH finds that withdrawal of immunomodulators after at least 6 months of co-treatment with infliximab does not reduce the trough levels of infliximab in patients with Crohn's disease.

Clinical Gastroenterology & Hepatology
Restarting Infliximab in IBD Patients with Prior Loss of Response

Clinical Gastroenterology & Hepatology

Play Episode Listen Later Sep 8, 2014 17:32


An article and accompanying editorial in the September issue of CGH discuss reinitiating infliximab therapy for inflammatory bowel disease patients after a period of discontinuation. Dr. Kuemmerle speaks w/ editorial co-author Dr. Maria T. Abreu.

AGA Journals Video Podcast
Increased Effectiveness of Early Therapy With Anti--Tumor Necrosis Factor-α...

AGA Journals Video Podcast

Play Episode Listen Later Feb 25, 2014 5:08


Dr. Thomas D. Walters discusses his manuscript "Increased Effectiveness of Early Therapy With Anti--Tumor Necrosis Factor-α vs an Immunomodulator in Children With Crohn's Disease." To view the abstract http://bit.ly/1c6K0n7.

The Rheumatology Podcast
Frequency of anti-infliximab antibodies: patients with RA in routine care – (May 2013)

The Rheumatology Podcast

Play Episode Listen Later Jul 4, 2013 12:36


Professor Robert Moots and Dr Steven Young (University of Birmingham School of Immunity and Infection), discuss the therapeutic role of antibodies given directly to patients and their response to these antibodies. They review a paper by Krentil et al

The Rheumatology Podcast
Frequency of anti-infliximab antibodies: patients with RA in routine care – (May 2013)

The Rheumatology Podcast

Play Episode Listen Later Jul 4, 2013 12:36


Professor Robert Moots and Dr Steven Young (University of Birmingham School of Immunity and Infection), discuss the therapeutic role of antibodies given directly to patients and their response to these antibodies. They review a paper by Krentil et al

The Rheumatology Podcast
Frequency of anti-infliximab antibodies: patients with RA in routine care – (May 2013)

The Rheumatology Podcast

Play Episode Listen Later Jul 4, 2013 12:36


Professor Robert Moots and Dr Steven Young (University of Birmingham School of Immunity and Infection), discuss the therapeutic role of antibodies given directly to patients and their response to these antibodies. They review a paper by Krentil et al

Clinical Gastroenterology & Hepatology
Cost-Effective Treatment for Crohn's Disease Patients Who Lose Responsiveness to Infliximab

Clinical Gastroenterology & Hepatology

Play Episode Listen Later Jun 4, 2013 16:09


A study in the June issue of CGH looks at whether a test-based or empiric dose-escalation strategy is more cost-effective for treating Crohn's disease patients who have stopped responding to Infliximab. Dr. Kuemmerle speaks to Dr. Fernando S. Velayos.

RAVE: Rheumatoid Arthritis Vital Education
RAVE: Rheumatoid Arthritis Vital

RAVE: Rheumatoid Arthritis Vital Education

Play Episode Listen Later Jun 25, 2012 109:34


Dr. Clifton Bingham from the Johns Hopkins Arthritis Center begins with a review of current best practices, including the issues related to diagnosis. Dr. George Lawry will follow with an overview of the risks and benefits of biologic therapy for patients with RA before Dr. Bingham presents on emerging DMARDs.The second half of the nearly 2 hour presentation covers the subject of comorbidities, presented by Dr. Lawry, on how to recognize comorbidities and how to best manage them. Dr. Bingham will follow up with the presentation of two cases to offer a clinical perspective to recognizing and treating comorbidities.

Gastroenterology
Maintenance of Remission Among Patients With Crohn's Disease on Antimetabolite Therapy Following Infliximab Therapy

Gastroenterology

Play Episode Listen Later Dec 22, 2011 16:05


Maintenance of Remission Among Patients With Crohn's Disease on Antimetabolite Therapy After Infliximab Therapy Is Stopped. Dr. Kuemmerle speaks to the first author of this study in the January issue of Gastroenterology, Prof. Edouard Louis.

DAVE Project - Gastroenterology
CJC: Infliximab, Azathioprine, or Combination Therapy for Crohn

DAVE Project - Gastroenterology

Play Episode Listen Later Aug 17, 2010


Gastroenterology
Colectomy Rate Comparison After Treatment of Ulcerative Colitis With Placebo or Infliximab

Gastroenterology

Play Episode Listen Later Sep 29, 2009 14:23


A study in the October 2009 Gastroenterology compares colectomy rates following treatment of ulcerative colitis with placebo or infliximab

DAVE Project - Gastroenterology
CJC: Infliximab prevents Crohn's Disease Recurrence After Ileal Resection

DAVE Project - Gastroenterology

Play Episode Listen Later Mar 23, 2009


Gastroenterology
Infliximab Prevents Crohn's Disease Recurrence After Ileal Resection

Gastroenterology

Play Episode Listen Later Feb 27, 2009 11:46


Medizin - Open Access LMU - Teil 15/22
Persistent clinical efficacy and safety of anti-tumour necrosis factor \textgreeka therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response

Medizin - Open Access LMU - Teil 15/22

Play Episode Listen Later Jan 1, 2008


Background: There is insufficient evidence for the long-term efficacy and safety of anti-tumour necrosis factor therapy in patients with ankylosing spondylitis (AS). This is the first report on the treatment with infliximab over 5 years.Methods: As part of a multicentre randomised trial, 69 patients with active AS at baseline (BL) have been continuously treated with infliximab (5 mg/kg i.v. every 6 weeks)---except for a short discontinuation after 3 years (FU1). The primary outcome of this extension was remission according to the ASsessment in Ankylosing Spondylitis (ASAS) criteria at the end of year 5 of the study (FU2).Results: Of the 43 patients who completed year 3, 42 agreed to continue, 38 of which (90.5%) finished year 5 (55% of 69 initially). Partial clinical remission was achieved in 13 of 38 patients (34.2%) at FU1 and FU2. At FU2, the mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 2.5±1.9 (BL:6.4, FU1:2.5). BASDAI values

Medizin - Open Access LMU - Teil 14/22
Clinical response to withdrawal of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab (vol 7, pg R439, 2005)

Medizin - Open Access LMU - Teil 14/22

Play Episode Listen Later Jan 1, 2005


Sat, 1 Jan 2005 12:00:00 +0100 https://epub.ub.uni-muenchen.de/23773/1/ar1750.pdf Braun, J.; Sieper, J.; Rudwaleit, M.; Zeidler, H.; Sorensen, H.; Schneider, M.; Kellner, H.; Gromnica-Ihle, E.; Burmester, G.; Alten, R.; Zink, A.; Brandt, J.; Listing, J.; Baraliakos, X.

Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 02/19
Therapie der Spondylitis ankylosans mit dem monoklonalen chimären anti-TNF-Antikörper Infliximab (Remicade®):Klinische Wirksamkeit und Einfluss auf die HLA-Oberflächenexpression auf Lymphozyten mit besonderer Berücksichtigung von HLA-B27

Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 02/19

Play Episode Listen Later Jun 24, 2004


In der vorliegenden Arbeit wurden therapeutische und immunmodulatorische Effekte einer TNF-Blockade bei Patienten mit aktiver Spondylitis ankylosans untersucht. Hierzu wurde an 10 Patienten während einer 60wöchigen Infliximabtherapie eine Evaluation von Therapiewirksamkeit und -sicherheit, sowie eine durchflusszytometrische Analyse der HLA-Oberflächenexpression auf Lymphozyten vorgenommen. Von 8 Patienten wurde die Therapie ohne ernste Nebenwirkungen gut vertragen und führte zur raschen und dauerhaften Verbesserung der klinischen, laborchemischen und radiologischen Verlaufsparameter. Ein Patient entwickelte nach initialer Wirksamkeit ein sekundäres Therapieversagen, bei einem weiteren Patienten wurde die Therapie unter dem Verdacht eines medikamentös induzierten Lupus-Syndroms abgebrochen. Gegen Mitte des Behandlungszeitraumes konnte ein am deutlichsten auf den B-Lymphozyten ausgeprägter Anstieg der HLA-B27- und MHC-Klasse-I-Expression beobachtet werden. Die Expressionszunahme ist möglicherweise Ausdruck immunmodulatorischer Effekte, die mit der langfristigen Therapiewirksamkeit assoziiert sind. Für die Zunahme der Oberflächenexpression kommen folgende Mechanismen in Frage: 1. eine vermehrte intravasale Kompartimentierung primär hoch exprimierender Zellen oder 2. eine durch die TNF-Suppression induzierte Hochregulation einer zuvor niedrigeren HLA-B27-Oberflächenexpression. Angesichts unserer Ergebnisse und der aktuell in der Literatur verfügbaren Daten halten wir letzteren Mechanismus für wahrscheinlicher. Innerhalb dieses Erklärungsmodells ist die bei Therapiebeginn niedrigere HLA-B27-Expression bedingt durch die Expression einer verminderten Anzahl von HLA-B27-Molekülen oder aberranter β2m-freier Varianten, die durch die von uns verwendeten konformationsabhängigen Antikörpern nicht detektierbar sind. Unter Hemmung des TNF-Einflusses kommt es schließlich zur schrittweisen Wiederherstellung der physiologischen Prozessierung trimolekularer HLA-B27-Oberflächenantigene mit konsekutiv vermehrter AK-Bindung. Eine verminderte oder aberrante HLA-B27-Expression ist möglicherweise mit immunmodulatorischen Effekten im Sinne einer erhöhten Zelldepletion assoziiert. Durch die Reexpression trimolekularer HLA-B27-Moleküle wird die Interaktion zwischen immunkompetenten Zellen und HLA-B27-positiven Zellen beeinflusst, wodurch das Zellüberleben begünstigt wird. Dieser Erklärungsansatz ist vereinbar mit dem gegenwärtig favorisierten pathogenetischen Modell der fehlerhaften HLA-B27-Prozessierung und der derzeit diskutierten Beteiligung von TNF bei der Manifestation der AS.

Medizin - Open Access LMU - Teil 13/22
Safety aspects of infliximab in inflammatory bowel disease patients - A retrospective cohort study in 100 patients of a German University Hospital

Medizin - Open Access LMU - Teil 13/22

Play Episode Listen Later Jan 1, 2004


Background: Infliximab, a chimeric anti-tumour necrosis factor monoclonal antibody with potent anti-inflammatory effects, represents an effective treatment option in patients with severe inflammatory bowel disease (IBD). Serious side-effects of such an immunomodulating therapy are speculated and therefore we reviewed our clinical experience in a retrospective safety study looking upon a single cohort of 100 IBD patients from a large German University Hospital. Methods: 100 patients with severe Crohn's disease (n = 92), ulcerative colitis (n = 7) or indeterminate colitis (n = 1) treated with infliximab (5 mg/kg) from January 2000 to December 2003 were retrospectively analysed for acute and subacute adverse events by chart review. Results: Overall, infliximab therapy was generally well tolerated. No fatal complications, malignancies, autoimmune diseases, neurologic or cardiovascular complications were observed in the cohort during the study period. Overall, adverse events were observed in 10 patients: 2 patients showed an acute infusion reaction, 1 patient a serum sickness-like reaction, in 4 patients a bacterial or viral infection occurred, in 1 patient pancytopenia and 2 patients developed surgical complications. Only 6 patients with adverse events required admission to hospital. A case of tuberculosis after infliximab was not found. The lack of adverse side-effects was associated with young median age and infrequent comorbidities of the cohort. Conclusion: Regarding its strong immunomodulating capacity, infliximab appears to be an efficient and relatively safe therapeutic option for patients with severe IBD. However, the use of infliximab requires careful screening and close patient monitoring to identify patients at risk and the infrequent, but sometimes serious complications of infliximab. Copyright (C) 2004 S. Karger AG, Basel.