Impact of systemic therapies on SARS-CoV-2 antibody seroprevalence in patients with immune-mediated diseases. / Impacto de las terapias sistémicas en la seroprevalencia de anticuerpos contra el SARS-CoV-2 en pacientes con enfermedades inmunomediadas.

OBJECTIVE: To determine the seroprevalence of SARS-CoV-2 in patients with immune-mediated inflammatory diseases (IMID) treated with biologic (bDMARDs) or synthetic targeted disease-modifying antirheumatic drugs (tsDMARDs). METHODS: An observational, descriptive, prospective and cross-sectional study of analytical prevalence analysis was conducted in patients with IMID with bDMARDs or tsDMARDs. Seroprevalence was compared by measuring immunoglobulinG (IgG) against SARS-CoV-2 between October/2020 and May/2021. RESULTS: A total of 550 IMID's patients were studied, all of them on treatment with bDMARDs or tsDMARDs. The seroprevalence of the total patient group was 16% (88/550). Patients receiving therapy with tumor necrosis factor alpha inhibitors (TNFi) had a higher seroprevalence compared to other biologic and synthetic targeted therapies (OR: 1.792 [95%CI: 1.088-2.951]; P=.021). The influence on seroprevalence of concomitant use with b/tsDMARDs of conventional synthetic DMARDs (csDMARDs) was also analyzed. A lower seroprevalence was demonstrated in the group of patients treated with TNFi and methotrexate together, compared with those on TNFi monotherapy, 10.1 vs 24.1% (OR: 0.355 [95%CI: 0.165-0.764]; P=.006). No significant differences were found with the other DMARDs. Regarding IMIDs, no differences in seroprevalence were identified between the different disease groups. CONCLUSION: Patients on treatment with TNFα inhibitors have better humoral response compared to the other b/tsDMARDs. However, when associated with methotrexate the seroprevalence decreases significantly.

Seroprevalencia del SARS-CoV-2 en los pacientes con enfermedades inmunomediadas en tratamiento con terapias biológicas y sintéticos dirigidos

Introducción: La seroprevalencia del SARS-CoV-2 en las enfermedades inflamatorias inmunomediadas (IMID) sigue siendo fuente de controversia. Objetivo: Comparar la seroprevalencia de anticuerpos (Ac) anti SARS-CoV-2 en pacientes con IMID en tratamientos con fármacos antirreumáticos modificadores de la enfermedad biológicos (FAMEb) o sintéticos dirigidos (FAMEsd) frente a un grupo de personas sin IMID. Métodos: Estudio de pacientes con IMID y tratamientos con FAMEb y FAMEsd y de individuos sin IMID. Mediante la técnica de inmunoensayo por quimioluminiscencia indirecta, se determinaron las serologías IgG frente al SARS-CoV-2 entre octubre/2020 y mayo/2021. Resultados: Se estudiaron 1.100 sujetos, 550 pacientes con IMID y 550 personas sin IMID. Se observó una seroprevalencia de 16% (88/550) en los pacientes frente a 19,3% (106/550) en el grupo de personas sin IMID, sin significación estadística (OR 0,790 [IC 95% 0,558-1,118]). Comparando los tratamientos con FAMEb o FAMEsd, se observó una tendencia a una menor seroprevalencia con rituximab, en relación con los individuos sin IMID (OR 0,296 [IC 95% 0,0871,007]). Asimismo, se encontró menor seroprevalencia en los pacientes que además de su FAMEb recibían tratamiento con metotrexato, en comparación con el grupo de personas sin IMID (OR 0,432 [IC 95% 0,223-0,835]). Conclusiones: Las IMID en tratamiento con FAMEb o FAMEsd no influyen en la seroprevalencia frente al SARS-CoV-2 de los pacientes. El tratamiento concomitante con metotrexato disminuye de forma significativa la seroprevalencia en estos pacientes.

Background: The seroprevalence of SARS-CoV-2 in immunemediated inflammatory diseases (IMID) remains controversial. Aim: To compare the seroprevalence of antibodies (Ab) to SARS-CoV-2 in patients with IMID receiving treatment with biological diseasemodifying antirheumatic drugs (bDMARD) or targeted synthetic (tsDMARD) versus a group of people without IMID. Methods: Study of patients with IMID and treatments with bDMARD and tsDMARD and individuals without IMID. IgG serology against SARS-CoV-2 was measured using the two-step sandwich immunoassay technique by indirect chemiluminescence between October 2020 and May 2021. Results: A total of 1100 subjects were studied, 550 patients with IMID and 550 persons without IMID. A seroprevalence of 16% (88/550) was observed in patients versus 19.3% (106/550) in the group of people without IMID, without statistical significance (OR 0.790 [95% CI 0.558-1.118]). Comparing the treatments with bD- MARD or tsDMARD, there was a tendency to lower seroprevalence with rituximab, in relation to individuals without IMID (OR 0.296 [95% CI 0.087-1.007]). In addition, lower seroprevalence was found in patients who received methotrexate treatment in addition to their bDMARD, compared to the group of individuals without IMID (OR 0.432 [95% CI 0.223-0.835]). Conclusions: IMIDs in treatment with bDMARDs or tsDMARDs do not influence the seroprevalence against SARS-CoV-2 in patients. Concomitant treatment with methotrexate significantly decreased seroprevalence in these patients.

[Translated article] Biological and immunosuppressive medications in pregnancy, breastfeeding and fertility in immune mediated diseases.

OBJECTIVE: The objective of this review is to gather the available evidence on the different drugs used in immune-mediated inflammatory diseases in pregnancy, lactation, their influence on female and male fertility, advice on discontinuation before conception and to help in routine clinical practice for better patient advice on family planning. METHODS: A bibliographic search was carried out, where published articles (review studies, observational studies and case series) in English or Spanish until April 2020 that analyzed the management of pregnancy, lactation and/or fertility in patients on treatment in immune-mediated diseases were selected. RESULTS: A total of 95 references were selected and the information on each drug was synthesized in tables. Drugs contraindicated in pregnancy are topical retinoids, pimecrolimus, cyclooxygenase 2 inhibitors, methotrexate, mycophenolate mofetil, leflunomide, acitretin, and thiopurines. The lack of data advises against the use of apremilast, tofacitinib, baricitinib, anakinra, abatacept, tocilizumab and the new biologicals. Topical salicylates, paracetamol, ultraviolet therapy and hydroxychloroquine treatment are safe, and anti-TNF biological therapy are considered low risk, with certolizumab being the drug of choice throughout pregnancy and lactation. Most are compatible with paternal exposure except for sulfasalazine, mycophenolate and leflunomide, for which suspension of treatment prior to conception is recommended, and cyclosporine with dose requirements of less than 2 mg/kg/day. CONCLUSIONS: In this context of chronic treatments with teratogenic potential, it is necessary to highlight the importance of pregnancy planning to select the safest drug. Given the quality of the available data, it is still necessary to continuously update the information, as well as to promote observational studies of cohorts of pregnant patients and men of childbearing age, including prospective studies, in order to generate more scientific evidence.

Biological and immunosuppressive medications in pregnancy, breastfeeding and fertility in immune mediated diseases. / Medicamentos inmunosupresores y biológicos en el embarazo, la lactancia y la fertilidad en enfermedades inmunomediadas.

OBJECTIVE: The objective of this review is to gather the available evidence on the different drugs used in immune-mediated inflammatory diseases in pregnancy, lactation, their influence on female and male fertility, advice on discontinuation before conception and to help in routine clinical practice for better patient advice on family planning. METHODS: A bibliographic search was carried out, where published articles (review studies, observational studies and case series) in English or Spanish until April 2020 that analyzed the management of pregnancy, lactation and/or fertility in patients on treatment in immune-mediated diseases were selected. RESULTS: A total of 95 references were selected and the information on each drug was synthesized in tables. Drugs contraindicated in pregnancy are topical retinoids, pimecrolimus, cyclooxygenase 2 inhibitors, methotrexate, mycophenolate mofetil, leflunomide, acitretin, and thiopurines. The lack of data advises against the use of apremilast, tofacitinib, baricitinib, anakinra, abatacept, tocilizumab and the new biologicals. Topical salicylates, paracetamol, ultraviolet therapy and hydroxychloroquine treatment are safe, and anti-TNF biological therapy are considered low risk, with certolizumab being the drug of choice throughout pregnancy and lactation. Most are compatible with paternal exposure except for sulfasalazine, mycophenolate and leflunomide, for which suspension of treatment prior to conception is recommended, and cyclosporine with dose requirements of less than 2mg/kg/day. CONCLUSIONS: In this context of chronic treatments with teratogenic potential, it is necessary to highlight the importance of pregnancy planning to select the safest drug. Given the quality of the available data, it is still necessary to continuously update the information, as well as to promote observational studies of cohorts of pregnant patients and men of childbearing age, including prospective studies, in order to generate more scientific evidence.

Medicamentos inmunosupresores y biológicos en el embarazo, la lactancia y la fertilidad en enfermedades inmunomediadas / Biological and immunosuppressive medications in pregnancy, breastfeeding and fertility in immune mediated diseases

Objetivo: El objetivo de esta revisión es reunir la evidencia disponible de los diferentes medicamentos utilizados en las enfermedades inflamatorias inmunomediadas en la gestación y lactancia, su influencia en la fertilidad femenina y masculina, consejos sobre su suspensión antes de la concepción y servir de ayuda en la práctica clínica habitual para un mejor consejo al paciente en la planificación familiar.Métodose realizó una búsqueda bibliográfica, donde se seleccionaron los artículos publicados (estudios de revisión, observacionales y series de casos) en lengua inglesa o española hasta abril de 2020 que analizaban el manejo del embarazo, la lactancia y/o la fertilidad en pacientes con tratamientos utilizados en las enfermedades inflamatorias inmunomediadas de dermatología, reumatología y digestivas.Resultadosse seleccionaron un total de 95 referencias y se sintetizó la información de cada medicamento en tablas. Los fármacos contraindicados en el embarazo son los retinoides tópicos, pimecrolimus, inhibidores de la ciclooxigenasa 2, metotrexato, micofenolato de mofetilo, leflunomida, acitretina y tiopurinas. La falta de datos desaconseja el uso de apremilast, tofacitinib, baricitinib, anakinra, abatacept, tocilizumab y los nuevos biológicos. Mientras que son seguros los salicilatos y los emolientes tópicos, el paracetamol, la terapia ultravioleta, la hidroxicloroquina y en la terapia biológica los anti-TNF se consideran de bajo riesgo, siendo el certolizumab el de elección durante todo el embarazo y la lactancia. La mayoría son compatibles con la exposición paterna, excepto algunos como la sulfasalazina, micofenolato y leflunomida, que se recomienda la suspensión del tratamiento previa a la concepción, y la ciclosporina con requerimientos de dosis inferiores a 2 mg/kg/día. (AU)

Objective: The objective of this review is to gather the available evidence on the different drugs used in immune-mediated inflammatory diseases in pregnancy, lactation, their influence on female and male fertility, advice on discontinuation before conception and to help in routine clinical practice for better patient advice on family planning.MethodsA bibliographic search was carried out, where published articles (review studies, observational studies and case series) in English or Spanish until April 2020 that analyzed the management of pregnancy, lactation and/or fertility in patients on treatment in immune-mediated diseases were selected.ResultsA total of 95 references were selected and the information on each drug was synthesized in tables. Drugs contraindicated in pregnancy are topical retinoids, pimecrolimus, cyclooxygenase 2 inhibitors, methotrexate, mycophenolate mofetil, leflunomide, acitretin, and thiopurines. The lack of data advises against the use of apremilast, tofacitinib, baricitinib, anakinra, abatacept, tocilizumab and the new biologicals. Topical salicylates, paracetamol, ultraviolet therapy and hydroxychloroquine treatment are safe, and anti-TNF biological therapy are considered low risk, with certolizumab being the drug of choice throughout pregnancy and lactation.Most are compatible with paternal exposure except for sulfasalazine, mycophenolate and leflunomide, for which suspension of treatment prior to conception is recommended, and cyclosporine with dose requirements of less than 2mg/kg/day. (AU)

Características de pacientes con enfermedades inflamatorias inmunomediadas hospitalizados por infección por SARS-CoV-2 / Characteristics of Patients With Immune-Mediated Inflammatory Diseases Hospitalized for SARS-CoV-2 Infection

Fundamentos: Las enfermedades inflamatorias inmunomediadas (IMID) predisponen a un aumento del riesgo infeccioso al modificar la respuesta inmune del huésped, que resulta crucial para la resolución de la infección por SARS-CoV-2. Las últimas publicaciones indican que los pacientes con IMID y sus tratamientos de base no empeoran el pronóstico de la infección por SARS-CoV-2. Objetivos: Describir las características clínicas y la evolución de pacientes con IMID que requirieron ingreso hospitalario por infección por SARS-CoV-2. En segundo lugar, comparar las características clínicas y la evolución entre pacientes que requirieron ingreso hospitalario por infección por SARS-CoV-2 con IMID y aquellos que no la presentaban. Métodos: Estudio observacional de cohortes retrospectivo, que incluyó pacientes ingresados por sospecha de SARS-CoV-2, tratados según el criterio médico y los protocolos basados en la evidencia científica. La recogida de datos clínicos se realizó por descarga directa o mediante revisión manual de la historia clínica electrónica. El análisis estadístico determinó las diferencias de características y evolución clínica de la infección en pacientes con IMID. Resultados: De los 612 pacientes revisados, 23 padecían IMID y 9 de ellos fueron diagnosticados de infección por SARS-CoV-2. No se observó correlación entre infección por SARS-CoV-2 e IMID. Los pacientes con IMID presentaban mayor prevalencia de enfermedad cardiovascular y obesidad, aunque no significativamente. Asimismo, los pacientes con IMID no presentaron una evolución clínica durante el ingreso hospitalario diferente respecto al resto de pacientes. Conclusión: Las IMID y los tratamientos de las mismas no determinan el pronóstico del ingreso hospitalario de la infección por SARS-CoV-2.(AU)

Background: Immune-mediated inflammatory diseases (IMID) predispose to a higher infection risk by modifying the host's immune response, which acts as a key factor in SARS-CoV-2 infection resolution. Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection. Objectives: To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection. Secondly, to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected. Methods: We performed an observational retrospective cohort study, including admitted patients with suspected SARS-CoV-2 infection, treated according to medical criteria and local protocols based on the best available scientific evidence. Clinical data were collected from their electronical clinical history. Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients. Results: Of a total number of 612 revised patients, 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection. We did not observe a correlation between these two disorders. There was a higher frequency of obesity and cardiovascular disease among IMID patients, but without statistical significance. The clinical outcomes were no different between hospitalized IMID and non IMID patients. Conclusion: IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection.(AU)

Importance of family planning in patients with immune-mediated inflammatory diseases: A multidisciplinary approach.

BACKGROUND AND OBJECTIVES: Family planning in women with immune-mediated inflammatory diseases is a challenge for healthcare teams, highlighting the need for standardized available evidence to provide patients with objective and agreed information. This study reflects the work performed by a multidisciplinary team in reviewing available scientific evidence, and the strategy agreed for family planning, pregnancy, postpartum, and breastfeeding in patients with immune-mediated inflammatory diseases. METHODS: A literature search was conducted, information was structured across the different stages (preconception, pregnancy, postpartum and breastfeeding), and an on-site meeting was convened, in which patients and healthcare providers participated. RESULTS: Specific materials, which are included in this work, were developed to guide clinical decisions to be agreed upon by patients and healthcare providers. CONCLUSION: These materials meet the need for validated and updated information on the approach and use of indicated drugs for professionals responsible for the management of immune-mediated inflammatory diseases.

Importancia de la planificación familiar en pacientes con enfermedades inflamatorias inmunomediadas: un abordaje multidisciplinar / Importance of family planning in patients with immune-mediated inflammatory diseases: a multidisciplinary approach

Antecedentes y objetivo: El reto terapéutico que supone para los equipos asistenciales la planificación familiar en mujeres con enfermedades inflamatorias inmunomediadas remarca la necesidad de armonizar la evidencia disponible para proporcionar a las pacientes información objetiva y consensuada. Este artículo refleja el trabajo realizado por un equipo multidisciplinar de revisión de la evidencia científica disponible y la estrategia de actuación consensuada en la planificación familiar, embarazo, posparto y lactancia materna de pacientes con enfermedades inflamatorias inmunomediadas. Métodos: Se realizó una búsqueda bibliográfica, se estructuró la información a lo largo de las diferentes etapas (preconcepción, embarazo, posparto y lactancia materna) y se realizó una reunión presencial para consensuar dicha información en la que participaron tanto pacientes como profesionales de la salud. Resultados: Se desarrollaron materiales específicos incluidos en este trabajo y que pueden servir de guía en la toma de decisiones consensuada entre pacientes y profesionales de la salud. Conclusión: Estos materiales responden a la necesidad de que los profesionales responsables del manejo de pacientes con enfermedades inflamatorias inmunomediadas posean información validada y actualizada sobre las actuaciones y el uso de fármacos indicados para estas enfermedades.(AU)

Background and objectives: Family planning in women with immune-mediated inflammatory diseases is a challenge for healthcare teams, highlighting the need for standardized available evidence to provide patients with objective and agreed information. This study reflects the work performed by a multidisciplinary team in reviewing available scientific evidence, and the strategy agreed for family planning, pregnancy, postpartum, and breastfeeding in patients with immune-mediated inflammatory diseases. Methods: A literature search was conducted, information was structured across the different stages (preconception, pregnancy, postpartum and breastfeeding), and an on-site meeting was convened, in which patients and healthcare providers participated. Results: Specific materials, which are included in this work, were developed to guide clinical decisions to be agreed upon by patients and healthcare providers. Conclusion: These materials meet the need for validated and updated information on the approach and use of indicated drugs for professionals responsible for the management of immune-mediated inflammatory diseases.(AU)

Characteristics of patients with immune-mediated inflammatory diseases hospitalized for SARS-CoV-2 infection.

BACKGROUND: Immune-mediated inflammatory diseases (IMID) predispose to a higher infection risk by modifying the host's immune response, which acts as a key factor in SARS-CoV-2 infection resolution. Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection. OBJECTIVES: To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection. Secondly, to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected. METHODS: We performed an observational retrospective cohort study, including admitted patients with suspected SARS-CoV-2 infection, treated according to medical criteria and local protocols based on the best available scientific evidence. Clinical data were collected from their electronical clinical history. Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients. RESULTS: Of a total number of 612 revised patients, 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection. We did not observe a correlation between these two disorders. There was a higher frequency of obesity and cardiovascular disease among IMID patients, but without statistical significance. The clinical outcomes were no different between hospitalized IMID and non IMID patients. CONCLUSION: IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection.

Encuesta a profesionales sanitarios y pacientes sobre el papel del farmacéutico en la Unidad de Enfermedades Inflamatorias Inmunomediadas / The role of the pharmacist within an immune-mediated inflammatory disease unit: Results of a survey of healthcare providers and patients

Objetivo: Evaluar el interés y necesidad de que el farmacéutico desarrolle nuevas actividades propuestas, y potenciar o mantener otras que yase realizaban, antes de que la futura Unidad de Enfermedades Inflamatorias Inmunomediadas inicie su actividad en nuestro hospital. Además,priorizar la incorporación de las nuevas actividades en base a los resultados obtenidos.Método: Diseño observacional transversal unicéntrico mediante unaencuesta realizada en enero de 2020 a todos los profesionales sanitarios de los servicios clínicos implicados y a una muestra de pacientes, yestructurada en dos categorías: Acciones orientadas a la atención farmacéutica al paciente y Acciones orientadas a los profesionales de dichaUnidad. Cada ítem se puntuó de 0 a 10, siendo 10 el máximo interés/necesidad. Se aplicó una matriz de priorización para cuantificar y evaluar cada actividad e implantar las nuevas por orden de priorización.Resultados: Se completaron 90 encuestas (30 de pacientes y 60 deprofesionales). Se analizaron las medianas obtenidas de cada una de las20 actividades propuestas, alcanzándose valores entre 8 y 10. Se compararon valores: en el grupo de farmacéuticos versus médicos se obtuvieron más ítems con diferencias estadísticamente significativas que en elgrupo farmacéuticos versus enfermería, o farmacéuticos versus pacientes. (AU)

Objective: To evaluate the importance and need for pharmacists toexpand their role to new activities and to promote and maintain othersthey already carried out prior to the implementation of a new Immunemediated Inflammatory Diseases Unit to be created in our hospital; toprioritize the new activities incorporated based on the results obtained.Method: This was a single center cross-sectional based on a survey administered during January 2020 to all clinical healthcare providers due to bepart of the new unit, as well as to a sample of patients. It was structuredinto two categories: actions related to patients’ pharmaceutical care, andactions related to practitioners of the Immune-mediated Inflammatory Diseases Unit. Each item was assigned a score from 0 to 10, where 10 indicatedmaximum interest or need. A prioritization template was applied to quantifyand evaluate each activity and implement the new ones in order of priority.Results: A total of 90 responses were obtained (30 from patients and60 from healthcare workers). An analysis was performed of the medianscores of each of the 20 activities proposed, which ranged between 8 and10 points. When comparing the scores obtained, it was observed thatmore statistically significant differences were obtained in the pharmacists vsdoctors group than in the pharmacists vs nurses group, or the pharmacistsvs patients one. After prioritization, the first action taken was to implement electronic prescriptions for outpatients with immune-mediated inflammatorydiseases. (AU)

Characteristics of Patients With Immune-Mediated Inflammatory Diseases Hospitalized for SARS-CoV-2 Infection. / Características de pacientes con enfermedades inflamatorias inmunomediadas hospitalizados por infección por SARS-CoV-2.

BACKGROUND: Immune-mediated inflammatory diseases (IMID) predispose to a higher infection risk by modifying the host's immune response, which acts as a key factor in SARS-CoV-2 infection resolution. Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection. OBJECTIVES: To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection. Secondly, to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected. METHODS: We performed an observational retrospective cohort study, including admitted patients with suspected SARS-CoV-2 infection, treated according to medical criteria and local protocols based on the best available scientific evidence. Clinical data were collected from their electronical clinical history. Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients. RESULTS: Of a total number of 612 revised patients, 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection. We did not observe a correlation between these two disorders. There was a higher frequency of obesity and cardiovascular disease among IMID patients, but without statistical significance. The clinical outcomes were no different between hospitalized IMID and non IMID patients. CONCLUSION: IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection.

Importance of family planning in patients with immune-mediated inflammatory diseases: a multidisciplinary approach. / Importancia de la planificación familiar en pacientes con enfermedades inflamatorias inmunomediadas: un abordaje multidisciplinar.

BACKGROUND AND OBJECTIVES: Family planning in women with immune-mediated inflammatory diseases is a challenge for healthcare teams, highlighting the need for standardized available evidence to provide patients with objective and agreed information. This study reflects the work performed by a multidisciplinary team in reviewing available scientific evidence, and the strategy agreed for family planning, pregnancy, postpartum, and breastfeeding in patients with immune-mediated inflammatory diseases. METHODS: A literature search was conducted, information was structured across the different stages (preconception, pregnancy, postpartum and breastfeeding), and an on-site meeting was convened, in which patients and healthcare providers participated. RESULTS: Specific materials, which are included in this work, were developed to guide clinical decisions to be agreed upon by patients and healthcare providers. CONCLUSION: These materials meet the need for validated and updated information on the approach and use of indicated drugs for professionals responsible for the management of immune-mediated inflammatory diseases.