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Infusion Services

Remicade - Infliximab


For the most up-to-date information - please visit the Official Remicade - Infliximab website by clicking HERE.  Remicade, is a newer type of drug for Crohn's disease... a real breakthrough. It is an antibody that blocks a substance called TNF. (TNF stands for "Tumor Necrosis Factor" - but this has nothing to do with tumors or cancer.) This newly discovered protein has been found in the blood of patients with active inflammation like Crohn's disease and Rheumatoid Arthritis. In Crohn's disease, it is felt that TNF plays an important role in causing inflammation and damage of the intestinal wall. In fact, evidence to date strongly suggests a central role for TNF in Crohn's disease. Overproduction of TNF may lead to a flare-up of Crohn's symptoms. Why this occurs is just some individuals is still a mystery.


A biological agent is a "designer molecule" made to hit a specific target. Remicade is a new biological agent that was made to target only TNF. It is co-produced in mice and the final product is about 75% human and 25% mouse antibody. Remicade helps control the symptoms of Crohn's disease by binding to TNF and neutralizing its action. Because Remicade blocks TNF in Crohn's patients, it is sometimes called an "anti-TNF antibody." Remicade was approved by the FDA in May 1998 for treatment of Crohn's disease. It was recently also approved to treat patients with Rheumatoid Arthritis whom also seem to have an excess amount of TNF in their joints.

Who should receive Remicade?

Remicade is currently reserved for patients with active signs and symptoms of Crohn's disease who fail to adequately control their disease with convential therapy - prednisone, Pentasa, Asacol, Imuran, etc.


How is Remicade administered?

Unlike most medications for Crohn's, Remicade is given as a solution by intravenous infusion (into a vein). This infusion may be given in your doctor's office, or at an infusion center, or in an outpatient setting your doctor selects. The actual infusion takes 2 hours. You should plan on spending about 3 hours, which includes preparation. During this time, the nurse will check on you at regular intervals. The infusion is not sedating and most patients are able to drive home. Current dosage recommendations are:


  • For moderately to severely active Crohn's disease without fistulas, a single infusion is recommended
  • For Crohn's patients with fistulas, three infusions (an initial infusion, then one 2 weeks later and one 6 weeks later) are recommended


What are the benefits of Remicade?

This is a new drug and there is much to learn - especially about the risks and benefits. Short term studies look promising. One recent study of 108 patients reported that 4 weeks after one dose, 82% of people who received the recommended dose had improvement in the signs and symptoms of their Crohn's disease, compared to only 16% of the people who received a placebo. ?Almost half experienced complete disappearance of their Crohn's symptoms at one month.


Healing of intestinal fistulas

Another indication for Remicade is to help close intestinal fisulas. Common in Crohn's disease, a fistula is simply an abnormal "tunnel" that makes a path between two body cavities - such as between intestine and vagina, intestine and bladder, or from the intestine and through skin. One way a fistula may form is from an abscess - a pocket of pus in the body. The abscess may be constantly filling with body fluids such as stool or urine, which prevents healing. Eventually the fistula breaks through to the skin, another body cavity, or an organ. Fistulas are more common in Crohn's Disease than in ulcerative colitis. Approximately 30% of people with Crohn's Disease develop fistulas.


Until Remicade, there really was no generally effective medical therapy to help close a fistula. Antibiotics work only sometimes and major surgery was often required. Recent information suggests that Remicade may be of benefit in this situation. One clinical study looked at the effects of Remicade on healing of fistulas in 94 patients with Crohn's disease. About 68% of patients receiving the recommended dose of Remicade had at least half of their fistulas close for at least 1 month, compared to 26% of people who received a placebo. About? 55% of patients had all of their fistulas close for at least 1 month, compared to 13% of people who received a placebo.


Can you predict which patients will best respond to Remicade?

No. As you see above, not every patient responds to this medication. It would be helpful to predict in advance who will respond and who will not. There have been a number of attempts to determine which Crohn's patients will likely benefit. So far, initial studies have been unable to determine specific factors that would predict a beneficial response. The only way to find out is to try it.


What if I have a stricture in my small intestine?

Remicade probably won't help. The natural history of Crohn's disease is to form ulcers on the inner intestinal wall which heal and then return over and over. Each time an ulcer heals some scar tissue (fibrosis) is formed. This scar tissue can accumulate over time and cause a narrowing in the small intestine or colon. This is called a stricture. A significant percentage of individuals may develop intestinal obstruction, or "blockage of the bowels," from these strictures. Remicade works best in reducing active inflammation, but has little effect on scar tissue which may be permanent. Reports have demonstrated that individuals who have intestinal strictures are less likely to respond to Remicade.


How long does Remicade last?

The bad news is that this beneficial effect seems temporary. While Remicade has been shown in medical studies to heal the lining of the intestine, a single dose has been shown to provide full benefit for only 8 to 12 weeks, on average. Still, about 20% of patients still show a positive effect at 44 weeks.


What are the side effects?

In medical studies, most people had no side effects related to Remicade. Remicade infusions are usually well tolerated. Immediate side effects occur in about 5% of patients and include headache, nausea, itching, stinging, dizziness, fatigue, and fever and did not last long. Only 2% of people had to stop the infusion because of side effects. The infusion-related reactions, if they occurred, were typically mild, requiring reduction of infusion rate, administration of acetaminophen, and/or Benedryl. Pre-treatment with Tylenol and Benedryl may be of benefit. Serious infusion-related reactions are uncommon, but can occur. That is why it is best to have the infusion in a controlled safe environment.


Some patients develop antibodies to Remicade that may result, rarely, in the development of a lupus-like syndrome. Recent data show this to occur in less than 1% of patients. Symptoms included migratory joint pain, pleuritis, and rash. There were no kidney or central nervous system symptoms. These symptoms resolved by simply stopping treatment and a short couse of steroids.

Rarely serious side effects may occur. Since this treatment partially blocks your immune system, patients treated with Remicade may have an increased risk of infection. The infections most frequently reported were upper respiratory tract infections (including, sinusitis, pharyngitis, and bronchitis) and urinary tract infections. Rarely, serious infections have been reported in patients, some fatal. You should not take Remicade if you have an acute or chronic infection.


Can Remicade give me cancer?

In the short term, no. Despite some intitial concerns, recent studies show no statistically significant increased incidence of cancer in individuals who were treated with Remicade compared with controls in the Crohn's disease studies or in all studies. This is a new drug. Of course, long term safety studies are ongoing.


What does Remicade cost?

This novel medication is very expensive. Of course, there is no generic substitute. The usual dose is 5 mg per kilogram of weight administered over a two hour infusion. The average 70 kilogram person (154 pounds) would require 350 milligrams. The cost of this infusion would be about $2500. When given for proper indications, most insurance carriers will cover all or part of the cost. This varies by insurance company, so pre-authorization is usually required.


What about my other medications?

Most patients remain on the medications they are already taking for Crohn's disease - but started to see improvement in signs and symptoms after their Remicade infusion. Each case is different and only your doctor can determine what is right for you. Remicade is easily incorporated into your treatment program. Specific studies on drug interactions with Remicade have not been conducted. Be sure to let your doctor know all the medications you take, not just the ones you take for Crohn's disease.


Remember

Remicade is a powerful drug that seems promising for many Crohn's sufferers. Of course, it's not possible to predict in advance how you will respond to treatment with Remicade or how long the benefit will last. Side effects are usually minor, but serious side effects can occur. Long term effects will not be understood for several decades. It's important to discuss all of your treatment options with your doctor before deciding on any course of treatment.

Entyvio - vedolizumab


For the most up-to-date information on Entyvio (vedolizumab) please visit their official website by clicking HERE.  Entyvio (vedolizumab) reduces the effects of a substance in the body that can cause inflammation.


Entyvio is used in adults with moderate to severe ulcerative colitis(UC), or moderate to severe Crohn's disease.


Entyvio treats active disease and may help keep UC or Crohn's symptoms under control long term. Vedolizumab may also reduce the need for steroid medicines in helping to control symptoms long term.


Entyvio is usually given after other medicines have been tried without success.


Important information

You should not use Entyvio if you are allergic to vedolizumab.


Before taking this medicine

To make sure Entyvio is safe for you, tell your doctor if you have:

  • an active or recent infection;
  • tuberculosis (or if you have close contact with someone who has tuberculosis);
  • signs of infection such as fever, cough, or flu symptoms;
  • open sores or skin wounds;
  • weak immune system (caused by disease or by using certain medicine); or
  • if you are scheduled to receive any vaccines.


You should be up to date with all needed vaccinations before receiving Entyvio.


FDA pregnancy category B. Entyvio is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Stelara (ustekinumab)


For the most up-to-date information please visit the Stelara (ustekinumab) Official Website by clicking HERE. STELARA® (ustekinumab) is a prescription medicine that affects your immune system. STELARA® can increase your chance of having serious side effects including:


Serious Infections


STELARA® may lower your ability to fight infections and may increase your risk of infections. While taking STELARA®, some people have serious infections, which may require hospitalization, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses.


Your doctor should check you for TB before starting STELARA® and watch you closely for signs and symptoms of TB during treatment with STELARA®.  If your doctor feels that you are at risk for TB, you may be treated for TB before and during treatment with STELARA®.


You should not start taking STELARA® if you have any kind of infection unless your doctor says it is okay.


Before starting STELARA®, tell your doctor if you:
think you have an infection or have symptoms of an infection such as
  • fever, sweats, or chills
  • muscle aches
  • cough
  • shortness of breath
  • blood in phlegm
  • weight loss
  • warm, red, or painful skin or sores on your body
  • diarrhea or stomach pain
  • burning when you urinate or urinate more often than normal
  • feel very tired
  • are being treated for an infection
  • get a lot of infections or have infections that keep coming back
  • have TB, or have been in close contact with someone with TB


After starting STELARA®, call your doctor right away if you have any symptoms of an infection (see above). STELARA®can make you more likely to get infections or make an infection that you have worse. People who have a genetic problem where the body does not make any of the proteins interleukin 12 (IL‐12) and interleukin 23 (IL‐23) are at a higher risk for certain serious infections that can spread throughout the body and cause death. People who take STELARA® may also be more likely to get these infections.


Cancers

STELARA® may decrease the activity of your immune system and increase your risk for certain types of cancer. Tell your doctor if you have ever had any type of cancer. Some people who had risk factors for skin cancer developed certain types of skin cancers while receiving STELARA®. Tell your doctor if you have any new skin growths.

Reversible posterior leukoencephalopathy syndrome (RPLS)

RPLS is a rare condition that affects the brain and can cause death. The cause of RPLS is not known. If RPLS is found early and treated, most people recover. Tell your doctor right away if you have any new or worsening medical problems including: headache, seizures, confusion, and vision problems.


Serious Allergic Reactions

Serious allergic reactions can occur. Stop using STELARA® and get medical help right away if you have any symptoms of a serious allergic reaction such as: feeling faint, swelling of your face, eyelids, tongue, or throat, chest tightness, or skin rash.

Before receiving STELARA®, tell your doctor about all of your medical conditions, including if you:
  • have any of the conditions or symptoms listed above for serious infections, cancers, or RPLS.
  • ever had an allergic reaction to STELARA® or any of its ingredients. Ask your doctor if you are not sure.
  • are allergic to latex. The needle cover on the prefilled syringe contains latex.
  • have recently received or are scheduled to receive an immunization (vaccine). 

People who take STELARA®should not receive live vaccines. Tell your doctor if anyone in your house needs a live vaccine. The viruses used in some types of live vaccines can spread to people with a weakened immune system, and can cause serious problems. 

You should not receive the BCG vaccine during the one year before receiving STELARA® or one year after you stop receiving STELARA®.
  • have any new or changing lesions within psoriasis areas or on normal skin.
  • are receiving or have received allergy shots, especially for serious allergic reactions.
  • receive or have received phototherapy for your psoriasis.
  • are pregnant or plan to become pregnant. It is not known if STELARA® can harm your unborn baby. You and your doctor should decide if you will receive STELARA®.
  • are breastfeeding or plan to breastfeed. It is thought that STELARA® passes into your breast milk. Talk to your doctor about the best way to feed your baby if you receive STELARA®.

Tell your doctor about all the medicines you take, including prescription and over‐the‐counter medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.


When prescribed STELARA®:
  • Use STELARA® exactly as your doctor tells you to. STELARA® is intended for use under the guidance and supervision of your doctor.
  • STELARA® is intended for use under the guidance and supervision of your doctor. In children 12 years and older, it is recommended that STELARA® be administered by a healthcare provider. If your doctor decides that you or a caregiver may give your injections of STELARA® at home, you should receive training on the right way to prepare and inject STELARA®. Your doctor will determine the right dose of STELARA® for you, the amount for each injection, and how often you should receive it. Do not try to inject STELARA® yourself until you or your caregiver have been shown how to inject STELARA® by your doctor or nurse.


Common side effects of STELARA® include: 

upper respiratory infections, headache, and tiredness in psoriasis patients; joint pain and nausea in psoriatic arthritis patients; and upper respiratory infections, redness at the injection site, vaginal yeast infections, itching, urinary tract infections, and vomiting in Crohn’s disease patients. These are not all of the possible side effects with STELARA®. Tell your doctor about any side effect that you experience. 


Ask your doctor or pharmacist for more information.

Injectafer (ferric carboxymaltose injection)


For the most up-to-date information on Injectafer (ferric carboxymaltose injection) please visit the Official Website by clicking HERE.  When oral iron fails, it's time to consider IV iron. With Injectafer, infuse less often and replete more iron.  Injectafer offers evidence-based dosing, up to 1500mg of iron in just 2 administrations, separated by at least 7 days.  With Injectafer administrations, 100% of the iron enters the patient's bloodstream.  Injectafer® (ferric carboxymaltose injection) is an iron replacement product indicated for the treatment of iron deficiency anemia (IDA) in adult patients who have intolerance to oral iron or have had unsatisfactory response to oral iron, and in adult patients with non-dialysis dependent chronic kidney disease.


IMPORTANT SAFETY INFORMATION


Contraindications

Injectafer is contraindicated in patients with hypersensitivity to Injectafer or any of its inactive components.


Warnings & Precautions

Serious hypersensitivity reactions, including anaphylactic-type reactions, some of which have been life-threatening and fatal, have been reported in patients receiving Injectafer. Patients may present with shock, clinically significant hypotension, loss of consciousness, and/or collapse. Monitor patients for signs and symptoms of hypersensitivity during and after Injectafer administration for at least 30 minutes and until clinically stable following completion of the infusion. Only administer Injectafer when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions. In clinical trials, serious anaphylactic/anaphylactoid reactions were reported in 0.1% (2/1775) of subjects receiving Injectafer. Other serious or severe adverse reactions potentially associated with hypersensitivity which included, but were not limited to, pruritus, rash, urticaria, wheezing, or hypotension were reported in 1.5% (26/1775) of these subjects.


In clinical studies, hypertension was reported in 3.8% (67/1775) of subjects. Transient elevations in systolic blood pressure, sometimes occurring with facial flushing, dizziness, or nausea were observed in 6% (106/1775) of subjects. These elevations generally occurred immediately after dosing and resolved within 30 minutes. Monitor patients for signs and symptoms of hypertension following each Injectafer administration.


In the 24 hours following administration of Injectafer, laboratory assays may overestimate serum iron and transferrin bound iron by also measuring the iron in Injectafer.


Adverse Reactions

In two randomized clinical studies, a total of 1775 patients were exposed to Injectafer, 15 mg/kg of body weight, up to a single maximum dose of 750 mg of iron on two occasions, separated by at least 7 days, up to a cumulative dose of 1500 mg of iron. Adverse reactions reported by ≥2% of Injectafer-treated patients were nausea (7.2%); hypertension (3.8%); flushing/hot flush (3.6%); blood phosphorus decrease (2.1%); and dizziness (2.0%).

The following serious adverse reactions have been most commonly reported from the post-marketing spontaneous reports: urticaria, dyspnea, pruritus, tachycardia, erythema, pyrexia, chest discomfort, chills, angioedema, back pain, arthralgia, and syncope.


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