Find Out If You Qualify











Crohns and Colitis Trials

Find Out if You Qualify?

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Answer a few simple survey questions to learn if you qualify for clinical trials in your area.

CrohnsandColitisTrials.org is intended for U.S. audiences only.

Please review your entries:

1) Please select which of the following best describes your condition:

Diagnosed with Crohn’s Disease (CD)

Diagnosed with Ulcerative Colitis (UC)

Diagnosed with both Crohn’s and Ulcerative Colitis

Diagnosed with, or have symptoms of another chronic inflammatory bowel disease. Sometimes referred to as unclassified inflammatory bowel disease, or indeterminate colitis.

Not diagnosed with any of the above conditions

This is a required question. Please answer and resubmit.

2) Within the past month have you experienced any of the following symptoms: abdominal pain, diarrhea or fever

Yes

No

This is a required question. Please answer and resubmit.

3) If diagnosed with Ulcerative Colitis, do you know your severity (as defined by Total Mayo Score [TMS])?:

Severe UC (MCS/TMS of 11-12)

Moderate UC (6-10)

Mild UC (3-5)

None/remission (0-2)

Don't Know

N/A

This is a required question. Please answer and resubmit.

4) If diagnosed with Crohn’s disease, do you know your severity (CDAI score)?

Severe CD (CDAI >450)

Moderate (220-450)

Mild CD (150-220)

None/remission (<150)

Don't Know

N/A

This is a required question. Please answer and resubmit.

5) Please select any and all of the medications you are currently taking (select all that apply):

Aminosalicylates, such as 5-ASA and Sulfasalizine (Azulfidine®)

5-aminosalicylates (5-ASA) drugs include:
  • Asacol/Lialda/Delzcol/Salofalk/Pentasa/Canasa/Rowasa/Apriso (mesalamine)
  • Colazal/Giazo (balsalazide)
  • Azulfidine / Sulfazine (sulfasalazine)
  • Dipentum® (olsalazine)

Immunomodulators such as Imuran®, Azasan®, Purinethol®

Immunomodulators drugs include:
  • e.g. azathioprine
  • 6-mercaptopurine
  • methotrexate

TNF therapy, including Remicade®, Humira®, Simponi®, Cimzia®, Stelara®

Anti-tumor necrosis factor (TNF) therapy:
  • Remicade® (infliximab)
  • Humira® (adalimumab)
  • Simponi (golimumab)
  • Cimzia® (certolizumab pegol)
  • Stelara® (ustekinumab)

Monoclonal treatments, including Entyvio® and Tysabri®

Monoclonal antibodies drugs include:
  • Entyvio (vedolizumab)
  • Tysabri® (natalizumab)

Corticosteroids

Oral corticosteroids drugs include:
  • Prednisone
  • Prednisolone
  • Beclomethasone
  • Budesonide

Antidiarrheals

Antidiarrheals drugs include:
  • Loperamide (Imodium®)
  • Diphenoxylate with atropine (Lomotil®)

Probiotics

Probiotics drugs include:
  • Culturelle®
  • Saccharomyces boulardii

Not taking any medication for IBD/CD/UC

This is a required question. Please answer and resubmit.

6) Please select any and all of the medications you previously took, but don’t currently take (select all that apply):

Aminosalicylates, such as 5-ASA and Sulfasalzine (Azulfidine®)

Immunomodulators such as Imuran®, Azasan®, Purinethol®

TNF therapy, including Remicade®, Humira®, Simponi®, Cimzia®, Stelara®

Monoclonal treatments, including Entyvio® and Tysabri®

Corticosteroids

Antidiarrheals

Probiotics

Never took medication for IBD/CD/UC

This is a required question. Please answer and resubmit.

7) I am currently enrolled in a clinical trial

Yes

No

This is a required question. Please answer and resubmit.

8) Are you willing to undergo a colonoscopy, if one is necessary, in order to participate in a study?

Yes

No

This is a required question. Please answer and resubmit.

9) Please select any and all of the following that apply to you (select all that apply):

Presence or history of fistula

Presence of colon polyps

Prior bowel resection or intestinal or intra-abdominal surgery

Have hepatitis B (HBV), hepatitis C (HCV) or HIV infection

Have active or latent tuberculosis (TB)

Alcohol dependency and/or substance abuse history

Parenteral alimentation/nutrition

Prior Ileostomy and/or colostomy

Active infection (e.g. C. difficile, infected abscess, CMV)

Currently Pregnant, or planning to become pregnant within 12 months

None of the above

This is a required question. Please answer and resubmit.

10) What is your 4-digit year of birth?

This is a required question. Please answer and resubmit.

11) What is your zip code?

This is a required question. Please answer and resubmit.

12) What is your email address?

This is a required question. Please answer and resubmit.
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