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John Haydek, MD MS

@jhaydek.bsky.social
65 followers 40 following 9 posts

IBD @uncgastro | Former GI at Colorado, @EmoryIMChiefs & @EmoryMedicine | #IBD & #Outcomes| Opinions my own. RT≠endorsement.

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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
Last, what are living guidelines? 🧑‍🍼 🔹 With how quick drug-development 💊 and treatment strategies ♟️ change, AGA will review new lit. 📄 and update recommendations 📝 as needed every 6 months. Stay tuned for updates in the future! 9/9
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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
✳️11-12 . For TNF + IMM therapy, when should you stop? ❌ stop TNF if combo therapy 🤷‍♂️ Knowledge gap: no recommendation on continuing IMM or when to stop 🗓️ ✳️13. For patients w/ mod-severe disease: 👍 Early advanced therapy ❌ No step-up 🪜 therapy ✳️14 If now on advanced 💊, stop 5-ASAs 8/9
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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
✳️8, ✳️9, ✳️10 Combo therapy 💊+💊 🔹 TNF + immunomodulator > TNF or IMM alone 🤷‍♂️Knowledge gap: no recommendation about whether IMM + non-TNF biologic is helpful 7/9
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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
✳️5, ✳️6, ✳️7. Immunomodulators 💊 ❌ Thiopurines for induction 👍 Okay to use thiopurines for maintenance ❌ Methotrexate for induction or maintenance 6/9
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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
❗️Important Points❗️ ❗️High🪣or med🪣 are recommended over lower🪣, but high🪣 is not necessarily > med 🪣 ❗️Factor in pt attributes when making tx choices, not just focusing efficacy buckets: 👨‍🦳age 🤰pregnancy status 🤒comorbidities 👩‍🦽functional status 🔅patient preferences 5/9
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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
What about comparative efficacy for bio-naïve & bio-exposed? ✳️3. Bionaïve💉💊 High🪣: IFX, VDZ, OZA, ETR, UPA, RISA, GUS Med🪣: GOL, UST, TOFA, FIL, MIRI Lower🪣: ADA ✳️4. Exposed💉💊 High🪣: TOFA, UPA, UST Med🪣: FIL, MIRI, RISA, GOL Low🪣: ADA, VDZ, OZA, ETR 4/9
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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
✳️1 & ✳️2: What is efficacy of 💊 compared to placebo for all-comers? High🪣: IFX, GOL, VDZ, TOFA, UPA, UST, OZA, ETR, RISA, GUS Med 🪣: ADA, FIL, MIRI Caveats 🔦 1. JAKis often 🙅‍♂️ for 1st line use per FDA 2. Biosimilar= originator 3. SC = IV 3/9
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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
But first, details 🤓 📍Developed using GRADE framework 📍Thresholds for clinically meaningful benefits across all 💊: >10% vs. pbo & >5% vs. other 💊 📍Provides guidance by stratifying of meds into 🪣s: high-, intermediate-, and lower-efficacy, for biologic-naïve and -exposed patients 2/9
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John Haydek, MD MS @jhaydek.bsky.social · 19/11/2024
🚨AGA New Guideline Alert🚨 🔗https://tinyurl.com/4dr3y5ms ▶️AGA Living Guideline: Pharmacological Management of Moderate-Severe Ulcerative Colitis I’ll break down its 14 recommendations down over the next 9 tweets 🧵 👇 #AGA #GI #UC #IBD 1/9
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