Thread by @DrsMeena

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 2/ 📸 Faculty disclosures & CME certification ℹ
Want a #CME certificate? → ℹ️ bit.ly/3IbTRdB
#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 3/ 😭 most pts are NOT getting safe 💉 like flu, pneumonia & HepB.
🤷‍♀️ Why?
🚫Many GIs won't/can't give 💉
❓Many PCPs don't know what to give
📞 Better communication is needed
#MondayNightIBD

Who do you think should make vaccine recs & where should pts w/ #IBD get 💉?

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 4/ pts w #IBD , esp if on ⚠️immunosuppressants (IS), at ⬆risk of (preventable) infections, so #vaccination is 🗝️
Infection in IBD = ⬆hospitalization ⬆ 🏥 stays ⬆costs & ⬆mortality.

Despite their benefits, vaccination rates remain LOW.

#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 5/ ☢️ Corticosteroids, immunomodulators, biologics & small molecules therapies significantly ⬆ the risk of infection in pts with #IBD.

#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 6/ 🚨#GITwitter #MondayNightIBD

47y/oM w #UlcerativeColitis about to start Tofacitinib.
Which of the following vaccines is recommended & should be given before/soon after he begins treatment with TOFA ?

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 7/ If you picked the recombinant zoster 💉, you are correct! 👏🥳
🚫 Varicella Zoster, or MMR ＝ live vax

🧩Who should get 💉?
✅ All #IBD pts 👉 standard + IBD-specific 💉 recs ➕ 🏡 household members

🛑 No live 💉 if IS
#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 8/ 🚨 #GITwitter #MondayNightIBD

If taken within the last 2-3 months, which of the following therapies does 🚫NOT constitute #systemic #immunosuppression in a patient with #IBD?

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 9/ 🧩Who is IS? #IBD pts on or had within last 3 months:
🚩 Prednisone > 20mg/day >2wks
🚩 AZA >2.5 mg/kg/day
🚩 6MP >1.5 mg/kg/day
🚩 MTX >0.4 mg/kg/week
🚩 Cyclosporine
🚩 Tacrolimus
🚩 Tofacitinib, ozanimod
🚩 TNFi, UST

Also:
🚩 Significant protein-calorie malnutrition

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 10/ 🚸Pediatric pts w #IBD & IS should be 💉 for pneumococcal disease + all routine scheduled 💉

📌If age >6yrs give PCV13 first 👉 wait 8wks before PPSV23
📌If age >2yrs, give 1st dose PPSV23 👉 2nd dose 5yrs later

@CrohnsColitisFn HCM in #IBD ✅🗒️ bit.ly/3GIMZUD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 11/ 🙋‍♀️19y/oF w #Crohns in clinical remission on IFX q8wk presenting today for #COVIDvax.

Pt asks about:
❓ #COVID-19 risks
❓💉👉 #IBD flare
❓🔢💉doses
❓mRNA vs Janssen

🧩What do you tell them?

#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 12/ All #IBD pts ≥5yrs 👉primary 💉 COVID-19 (mRNA Pfizer/Moderna pref over Janssen)

🚩 Mod-severe IS pts ≥5 yrs who complete 2-dose mRNA 👉💉 extra primary mRNA dose

✨BOOSTER DOSE: All pts ≥16yrs 👉💉 ≥5mos after mRNA series or ≥2mos after Janssen dose

#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 13/ IBD pts are NOT at ⬆ risk of #COVID-19 & do NOT need to stop meds to 👉#COVIDvax

✅Therapy important to keep #IBD in remission/prevent flares

#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 14/ Nov 2021 📶👉 COVID-19 💉EFFECTIVE✅ for #IBD pts 👏:

📌602 IBD pts vs 168 non-IS controls given mRNA or AstraZeneca 💉
📌82.2% of IBD pts on biologic tx, 48.5% on TNFi
📌Post💉 seropositivity 👉97.8% IBD pts vs 100% controls
📌ALL IBD pts w no seropositivity received AZ 💉

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 15/
March 2021📶👉 #COVIDvax SAFE✅ for #IBD pts 👏:

📌80% of study pts on IS therapy
📌AE freq similar to clinical trials: 39% after Dose 1, 62% after Dose 2
📌Biologic therapy 👉 fewer AEs after Dose 2 (p=0.013)

#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 16/
Pregnant #IBD pts and infants at 🚨HIGH RISK of SEVERE #COVID-19🚨

💉EARLY in 🤰pregnancy to ensure antibodies 👉👶
👉Pregnant minorities at increased risks COVID-19

#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 17/ SUMMARY:
📌#IBD pts @⬆risk of infection & neg outcomes
📌 All providers 👉evaluate💉status 👉all pts w IBD regardless of IS
📌#COVIDvax SAFE & recommended 👉all pts w IBD>5yrs
📌Special populations & racial/ethnic disparities 💥 considerations 👉💉& outcomes
#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn 18/ 🙌🙌🙌
Thanks from @MondayNightIBD @DCharabaty & @BonumCe 4 participating in this Tweetorial!

You did the 💪 work, now get🏅 🆓 #CME bit.ly/3I8mdp0

Before you 🏃🏽‍♀️, answer the post-test ❓s 👇
or in the 👆 CME🔗 if you want to claim credit
#MondayNightIBD

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn @BonumCe 19/ 🚨#PostConvo #IBDPoll 1⃣
#MondayNightIBD
🏆🆓 #CME 👉 bit.ly/3I8mdp0

47y/oM w #UlcerativeColitis about to start Tofacitinib. Which of the following vaccines is recommended & should be given before/🔜 after he begins treatment with TOFA?

@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma @CrohnsColitisFn @BonumCe 20/ 🚨#PostConvo #IBDPoll 2⃣
#MondayNightIBD
​​🏆🆓 #CME 👉 bit.ly/3I8mdp0

If taken within the last 2⃣-3⃣ months, which of the following therapies does 🚫NOT constitute #systemic #immunosuppression in a patient with #IBD?