Novel Approaches For IBD Care

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Novel Approaches For IBD Care
ECCO Nurses Network Meeting Lyon 2008

• Delivering Biological Therapies
• The Nurses Role

Samia MABROUKI Patricia DÉTRÉ Saint Louis
Hospital Paris
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Delivering Biological TherapiesThe Nurses Role

• Saint-Louis Hospital
• Our department
• Our activity in 2007
• All pre-therapy procedures
• Infliximab (Remicade)
• Adalimumab (Humira)
• Certolizumab (Cimzia)
• Conclusion

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Delivering Biological TherapiesThe Nurses Role
1. Saint-Louis Hospital, Paris, France

• 1607 founded
• 2007 400th Anniversary
• 2008 medical and paramedical personnel gt488
  other personnel gt 2 475

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Delivering Biological TherapiesThe Nurses Role

• 2. Our department

Gastroenterology Unit Pr Marc Lémann Activity
Day hospital (4 beds 3 chairs ) 10-12 patients
per day Inpatient unit (19 beds) Medical
staff 5 seniors 3 interns 7 GI attached to
GI dept Paramedical staff 17 nurses 2
Clinical Trial Assistants
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Delivering Biological TherapiesThe Nurses Role

• 2. Our department

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Delivering Biological TherapiesThe Nurses Role

• 2. Our department

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Delivering Biological TherapiesThe Nurses Role

• 3. Our activity

• 2120 patients with Crohns disease
• 1634 patients with Ulcerative Colitis
• In 2007 63 patients treated by Infliximab
• 14 patients treated by Adalimumab
• 4 patients treated by Certolizumab Pegol
• 25 patients treated in a Clinical Trial
• 9 MUSIC (Cimzia)
• 2 WELCOME (Cimzia)
• 9 CARE (Humira)
• 2 SONIC (Remicade)
• 5 ABATACEPT

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Delivering Biological TherapiesThe Nurses Role

• 3. Our activity

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Delivering Biological TherapiesThe Nurses Role

• 4. Pre-therapy procedures

• Nurses have to pre-screen patients before
  receiving Anti TNF therapy
• Chest X-ray
• TB test (PPD)
• Blood tests for Hep B, Hep C, HIV
• Verify vaccinations
• Inform patient about internet site
  www.lesantitnf.fr and free phone number 0 800 71
  80 80

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Delivering Biological TherapiesThe Nurses Role

• 5. Infliximab IV (1)

• To be checked before IFX infusion
• Weight
• Questionnaire regarding symptoms infections,
  disease activity, allergy
• Lab tests
• Blood pressure, pulse and temperature
• If all are Ok ? infusion can start
• If something wrong wait for the doctor

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Delivering Biological TherapiesThe Nurses Role

• 5. Infliximab IV (2)

• Premedication
• IV Steroids
• infusion of 200mg HSHC 30 min prior IFX
• Antihistaminic drug
• IV polaramine if necessary
• Infliximab prepared by nurse
• 5 mg/kg of infliximab (250 ml NaCl/ 2 hours)
• Under direct nurse supervision
• Monitoring of patient's BP every 30 min

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Delivering Biological TherapiesThe Nurses Role

• 5. Infliximab IV (3)

• Observation after the infusion for 2 hours for
  the three first infusions and 1 hour for the
  following
• Patient's education
• Patient must be seen by doctor before leaving
• Next appointment
• Prescriptions for other treatments and blood
  tests if required

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Delivering Biological TherapiesThe Nurses Role

• 6. Humira subcutaneous injection (1)

• Only for induction (1-3 injections)
• Check before injection
• Weight
• Questionnaire regarding symptoms infections,
  disease activity, allergy
• Lab tests
• Blood pressure, pulse and temperature

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Delivering Biological TherapiesThe Nurses Role

• 6. Humira subcutaneous injection (2)

• SC injection
• Patient's education for self-administration
  injections of SC Humira
• Nurses do the 1st injection and supervise the
  2nd and 3rd injections
• Patient's education
• Next appointment
• Prescriptions for SC Humira at home and other
  treatments if required

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Delivering Biological TherapiesThe Nurses Role

• 7. Cimzia subcutaneous injection (1)
• Awaiting EMEA approval from marketing
  authorization

• Check before injection
• Weight
• Questionaire
• Disease activity
• Blood test results
• Patient must be seen by doctor before injection
• Drug device provided by the Clinical Research
  Assistant
• Apply one Emla patch

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Delivering Biological TherapiesThe Nurses Role

• 7. Cimzia subcutaneous injection (2)
• awaiting EMEA approval from marketing
  authorization

• Cimzia is prepared by the nurse (30min)
• SC injection done by the nurse
• Observation during 2 hours for the two first
  injections and 1 hour for the others
• Next appointment
• Cimzia cannot be delivered for home injections
  at the moment (no approval)
• Prescriptions for other therapies if required

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Delivering Biological TherapiesThe Nurses Role

• 8. CONCLUSION

• Biologicals are not routine therapies
• The nurses training is the most important factor
  for patients'education
• Good communication and confidence with the
  patient is part of treatment sucess

Doctor
Patient
Nurse
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Delivering Biological TherapiesThe Nurses Role
Thanks for attention and Welcome to France