NAPLEX Question of the Week: Inflammatory Bowel Disease

The question of the week involves another rank question to get you thinking about IBD agents.

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JB is a 43 year old female is having multiple GI complaints and through eventual consultation with gastroenterology and workup is determined to have ulcerative colitis. Initial treatment options are being discussed with the gastroenterologist and frequency of administration is an important factor for her. She is a senior executive at her CPA practice and it is very difficult to leave her practice during the day especially during tax season.

Rank the following agents from least frequent maintenance dosing schedule to most frequent maintenance dosing schedule.

A. Azathioprine

B. Adalimumab

C. Infliximab

D. Methotrexate



Answer with rationale:

The correct order is C-B-D-A. There are a number of immunomodulatory agents used currently in the management of IBD including ulcerative colitis. Infliximab (Remicade) is generally given intravenously q 8 weeks in the maintenance phase, which would be very helpful for our busy patient. Adalimumab (Humira) is dosed every other week in those patients who demonstrate a clinical response within 8 weeks of therapy initiation. Methotrexate is given once weekly either IM or PO while azathioprine is administered orally daily.

While the question focuses on frequency of administration, dosing forms will be an important part of the decision process for our patient as you have IM, SQ, PO, and IV options available. A discussion of all factors related to the patient's options will be prudent. Even though infliximab is only given q8 weeks, she may elect to try oral therapy which would not require her leaving the office as much.

Knowledge of dosage forms and administration schedules is crucial for the examination. This expertise by pharmacists helps to ensure the best regimen is given to our patients based on their individual needs.

Christopher M. Bland

Clinical Associate Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Associate Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.