Chief of the Dr. Henry D. Janowitz Division of Gastroenterology
Dr. Burrill B. Crohn Professor of Medicine
Icahn School of Medicine at Mount Sinai
New York, NY

Bruce Sands, MD, MS is the Dr. Burrill B. Crohn Professor of Medicine. Dr. Sands is an expert in the management of inflammatory bowel diseases (IBD) and has earned an international reputation for his care of patients with complex and refractory disease. He joined Mount Sinai in 2010 as Chief of the Henry D. Janowitz Division of Gastroenterology. Prior to joining Mount Sinai, Dr. Sands was Medical Co-Director of the Crohn's & Colitis Center at Massachusetts General Hospital in Boston, where he most recently served as the hospital's Acting Chief of the Gastrointestinal Unit as well as Associate Professor of Medicine at Harvard Medical School.

A longtime advocate for the continued translational research in Crohn's disease and ulcerative colitis, Dr. Sands is widely recognized for his innovative treatment of IBD and for his clinical investigations of new therapeutics. He was among the first to report the efficacy of infliximab-a drug used to treat autoimmune diseases-in ulcerative colitis, a result later confirmed in large, multi-center randomized controlled trials. Dr. Sands was also principal investigator for the landmark ACCENT II study, an international project that demonstrated the efficacy of the anti-tumor necrosis factor antibody infliximab as a long-term treatment for fistulizing Crohn's disease.

Dr. Sands' research also explores IBD epidemiology and includes the creation of a population-based cohort of IBD in Rhode Island, a project that is being funded by both the National Institute of Health and the Centers for Disease Control and Prevention.

A leader in several major professional organizations, Dr. Sands is chair of the Clinical Research Alliance of the Crohn's Foundation of America and serves as Chair of the Immunology, Microbiology and Inflammatory Bowel Disease Section of the American Gastroenterological Association (AGA). He is an AGA Fellow (AGAF) and a fellow of the American College of Gastroenterology (FACG). In 2006 he was named Humanitarian of the Year by the New England Chapter of the Crohn's and Colitis Foundation of America, and the Massachusetts General Physician Organization honored him for "Excellence in Action" in recognition of his distinguished patient care.

His work has appeared in several leading peer-reviewed journals, including the New England Journal of Medicine, Gastroenterology and Gut. Dr. Sands is also a reviewer for many prominent publications, including the New England Journal of Medicine, and is an Associate Editor for the field's leading journal, Gastroenterology.

Dr. Sands received his medical degree at Boston University School of Medicine in Massachusetts and completed a residency in internal medicine at the Hospital of the University of Pennsylvania in Philadelphia. He then completed clinical and research fellowships at the Massachusetts General Hospital. In 2001 Dr. Sands also earned a Master of Science in Epidemiology at Harvard School of Public Health.

AWARDS
• Fellow: American College of Gastroenterology
• Fellow: American Gastroenterological Association
• 2010 Chair, Immunology, Microbiology & Inflammatory Bowel Disease Section
American Gastroenterological Association
• 2007 - 2010
Chair, Clinical Research Alliance
Crohn's & Colitis Foundation of America

RESEARCH
Dr. Sands' research as a clinical investigator focuses on extending basic pathogenetic observations in the inflammatory bowel diseases--Crohn's disease and ulcerative colitis--to translational research and clinical trials. I have been an active investigator in clinical trials of novel agents directed at specific pathophysiologic targets in IBD in all phases of study. His earliest clinical trial work was with infliximab, a chimeric monoclonal anti-tumor necrosis factor antibody that has revolutionized the treatment of Crohn's disease. Dr. Sands was among the first to report on the efficacy of infliximab in ulcerative colitis, later borne out in large randomized controlled trials. Dr. Sands was also overall principal investigator for a large randomized controlled trial of infliximab in fistulizing Crohn's disease, the largest such study to date. In addistion to his work in clinical trials, Dr. Sands's research has included extensive work in observational studies in IBD, including outcomes research and epidemiologic studies. Most recently, he is the principal investigator of OSCCAR, the Ocean State Crohn's & Colitis Area Registry, a novel, prospective, population-based inception cohort of inflammatory bowel disease based in the state of Rhode Island. The goals of this study are to 1) develope robust predictive models for outcomes in IBD, and 2) to elucidate the role of environmental risk factors in the onset of IBD.

Mount Sinai Hospital

The The GI Faculty Practice Associates physicians treat patients suffering from digestive disorders of all types, including cancerous, precancerous, and non-cancerous conditions.

A partial list of diseases and disorders that we treat routinely includes colitis, diverticular disease, peptic ulcers, gastroesophageal reflux disease (GERD), swallowing disorders, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), polyps, diseases of the esophagus, and cancers of the digestive system including malignancies of the esophagus, stomach, rectum, and colon.

Many of the physicians practicing in the Mount Sinai GI-FPA are ranked among the leading gastroenterologists in the country. As members of the faculty of the Mount Sinai School of Medicine, we are researchers as well as physicians.

In fact, research is a major part of our professional lives. And, because we’re on the staff of a major medical center, we are fortunate in being able to create, and refer to, the very latest research from all medical specialties including our own.

We’re also pleased to note that many of the diagnostic tools and treatments routinely used to care for digestive disorders today have been developed or refined by Mount Sinai gastroenterologists.

Every day of the year, the observations we make while treating patients are shaped into questions that are then tested through our research. The outcomes from this research then guide the individualized care we provide to every patient. Moreover, through publication in peer-reviewed medical journals, results from our clinical research are shared with physicians worldwide. The result is that we’re able to deliver tomorrow’s medicine today.

 Ustekinumab induction and maintenance therapy in refractory Crohn's disease.

 Dysfunction of the intestinal microbiome in inflammatory bowel disease and treatment.

 A randomised, double-blind, sham-controlled study of granulocyte/monocyte apheresis for moderate to severe Crohn's disease.

 A pooled analysis of infections, malignancy, and mortality in infliximab- and immunomodulator-treated adult patients with inflammatory bowel disease.

 Secukinumab, a human anti-IL-17A monoclonal antibody, for moderate to severe Crohn's disease: unexpected results of a randomised, double-blind placebo-controlled trial.

 Basiliximab does not increase efficacy of corticosteroids in patients with steroid-refractory ulcerative colitis.

 Abatacept for Crohn's disease and ulcerative colitis.

 A survey of current practice of venous thromboembolism prophylaxis in hospitalized inflammatory bowel disease patients in the United States.

 Evaluation of possible inflammatory bowel disease: a survey of Rhode Island physicians.

 Can endoscopy be avoided in the assessment of ulcerative colitis in clinical trials?

 Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS).

 Study to Determine Risk Factors for Post-operative Infection in Inflammatory Bowel Disease (PUCCINI)

Understanding of how best to treat inflammatory bowel disease (IBD) has evolved over the last ten years. Evidence now suggests that the most effective therapy early in the course of Crohn's disease (CD) and ulcerative colitis (UC) involves the use of immune suppressing medications such as the anti-Tumor Necrosis Factor (anti-TNF) agents infliximab, adalimumab, and certolizumab. However, many CD and UC patients still ultimately require surgery despite the use of these medications. Side effects of the anti-TNF agents include increased risk of infections due to their effect on the immune system. Little is known about how use of these medications near the time of surgery may affect patients' risks of infection or other post-operative complications. The only available studies on this topic have given conflicting results. These studies have been limited by the fact that they have been small in size and retrospective. Retrospective studies primarily involve chart review as the method of identifying potential risk factors for infections and other complications after they have already occurred. This method limits both the type and quality of information/data that can be collected. The conflicting results have led to variance in practice patterns with regards to management of anti-TNF agents, the timing of surgery, and even the types of surgery.

By enrolling patients at the time of their surgery, collecting extensive information may be possible than previously studied on potential risk factors for both infectious and non-infectious complications following surgery. Risk factors to be studied will include individual patient characteristics, disease characteristics, surgical methods, novel characteristics of CT scans and MRIs and extensive medication exposures. The primary objective is to determine if exposure to anti-TNF agents prior to surgery increases the risk of infection post-operatively. And evaluate exposure to anti-TNF agents by both patient history of use and measurement of anti-TNF drug levels at the time of surgery. Monitoring of drug levels at the time of surgery has never been utilized in this way to evaluate the risk of anti-TNF agents in IBD. However, this has been done to assess the risk of other medications in different diseases.

If anti-TNF agents are found to pose a risk for infectious or non-infectious outcomes in IBD patients undergoing surgery, change maybe needed in the way these medications are used around the time of surgery. Additionally, by collecting comprehensive information on other potential risk factors besides medication use patients at greatest risk for bad outcomes can be identified and take protective measures when possible. The aims of this study address the CCFA challenge to better define the risks of medical and surgical therapies to improve the quality of care of IBD patients undergoing surgery.

Estimated Enrollment: 1000
Study Start Date: February 2014
Estimated Study Completion Date: January 2017
Estimated Primary Completion Date: January 2017 (Final data collection date for primary outcome measure)

 Methotrexate in Induction and Maintenance of Steroid Free Remission in Ulcerative Colitis (Merit-UC)

Estimated Enrollment: 220
Study Start Date: February 2012
Estimated Study Completion Date: June 2016
Estimated Primary Completion Date: June 2015 (Final data collection date for primary outcome measure)

 Evaluating a Shared Decision Making Program for Crohn's Disease

Specific Aim: Study the impact of the Crohn's Disease Shared Decision Making Program on patients' treatment choice, persistence with chosen therapy, decision quality, cost of care, and outcomes

Hypothesis: The Crohn's Disease Shared Decision Making Program will help patients understand which treatments are right for them and will lead to a higher acceptance of appropriate therapy, improved persistence with chosen therapy, lower costs and improved clinical outcomes. To accomplish this aim, Investigators will perform a randomized controlled trial to:

Determine how the shared decision making program influences patients' choice of therapy
Evaluate how the shared decision making program affects persistence with chosen therapy
Determine how the shared decision making program affects decision quality
Determine how the shared decision making program influences cost of care and clinical outcomes

Expected Outcome and Impact: Investigators expect that this program will influence patients' choice of therapy, persistence with their preferred therapy, and lead to improved clinical outcomes. Investigators believe that this product can be successfully operationalized in the clinic to establish a new paradigm of how providers can communicate personalized treatment options to patients across a broad range of diseases.

Estimated Enrollment: 300
Study Start Date: March 2014
Estimated Primary Completion Date: July 2017 (Final data collection date for primary outcome measure)