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P567 Pharmacist-managed immunomodulator clinic in titration and monitoring of immunosuppressants in Inflammatory Bowel Disease

Ng, V.(1);Lim, T.G.(1,2);Ong, W.C.(1);Wong, S.Y.A.(1);Salazar, E.(3);Chan, P.W.W.(2,3);

(1)Singapore General Hospital- Singapore, Pharmacy, Singapore, Singapore;(2)Duke-NUS Medical School, Medicine, Singapore, Singapore;(3)Singapore General Hospital- Singapore, Gastroenterology and Hepatology, Singapore, Singapore

Background

Immunomodulators (IMs) such as azathioprine are the cornerstone in the treatment of inflammatory bowel disease (IBD). However, they are associated with significant toxicity and requires close monitoring for side effects, which puts a stretch on our physician clinics. The pharmacist-run Immuno Clinic (IMC) was set up in 2016 to assist in the monitoring of stable patients and initial titration phase of IMs so that physicians are able to focus their time and energy on patients with more complex diseases. The objective of this study is to demonstrate that IMC is able to effectively and safely carry out its purpose for patient’s disease management, medication adherence and adverse events management, resulting in time and cost savings.

Methods

This is a retrospective study looking at IBD patients who attended IMC from Aug 2016 to July 2019. Patients’ demographics, disease control, medication adherence and adverse effects were obtained from the IMC database. Descriptive data were analyzed using frequency distribution for categorical variables. Continuous variables were expressed as median and interquartile range (IQR).

Results

A total of 73 patients were included. Thirty-six (49.3%) patients had CD, while 37 (50.7%) patients had UC. A total of 185 actions were executed over 173 IMC sessions, including dose adjustment (57), recommending additional medications (14), discontinuation or restarting IM (12), side effects detection (25), monitoring recommendations (10), non-adherence detection (39), referral to physician (23), and others (5). In 2 out of 173 visits (1.1%), severe disease flare requiring hospitalization was detected and referred back to the primary physician for inpatient admission. Thirty ADRs were detected (17.3 %) and managed promptly. There were 24 cases of non-adherence detected and counselled (13.9%). Out of 38 patients who were referred for titration of IM, 28 patients (73.7%) achieved the target dose of IM. Patient visits were largely independently managed by pharmacists (150 out of 173, 86.7%).

Conclusion

Implementation of pharmacist-led IMC is a safe and cost-effective alternative to conventional gastroenterology clinic for monitoring and titration of IMs, enabling physicians to focus on more complicated cases and thus improving access to the IBD ambulatory care service.

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