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1. Evidence for using a top-down vs stepwise approach in severe UC finds that using biologic treatments earlier in the disease course can result in which of the following?
2. Using mucosal healing as a treatment target for UC has been shown to yield which of the following?
Steroid-resistant UC patients who have had an inadequate response to anti-TNF therapy should be:
4. If, after failing TNF inhibition, a request for treatment with biologic therapy is declined by the patient’s insurance company to try a different TNF inhibitor, clinicians should:
5. Michael, age 29, was initially diagnosed 4 years ago with UC. At first the disease was mild and controlled with a short-term course (2 weeks) of prednisone and 5-ASA (ie, oral mesalamine) maintenance therapy, which he took for 13 months. Michael discontinued the 5-ASA because he read on the internet that the headaches and pruritis he had been experiencing could have been caused by the mesalamine. He did not consult his physician about this because after he turned 26, he could no longer remain on his parent’s healthcare plan and felt he could no longer afford the 5-ASA nor a doctor’s visit. Additionally, since he hadn’t experienced any symptoms in over a year, he figured his UC was “cured”.
Almost 12 months later, Michael experienced a relapse. By this time, he was employed and had health insurance. He went to a gastroenterologist and was put on infliximab, a TNF inhibitor. After about 14 months, he began to experience flares again, each more severe than the last. He underwent a colonoscopy and was found to have pancolitis. Concerned that Michael was no longer responding the TNF inhibitor, his physician performed a full panel of blood work, including a test to assess serum concentration of infliximab and if Michael had developed anti-drug antibodies. Blood tests revealed that drug levels were adequate and there were no anti-drug antibodies. They also revealed that Michael had a high low-density lipoprotein cholesterol level of 175 mg/dL. What should his physician prescribe now?