P610 Optimising biological therapy in inflammatory bowel disease patients: the role of a virtual biological clinic
J. REES, C. Maher, J. Jones, J. Slater, B. Bates, D. Rattehalli, S. De Silva
Russells Hall Hospital, Gastroenterology, Dudley, UK
Background
The National Institute of Clinical Excellence (NICE) recommends that patients with inflammatory bowel disease (IBD) taking biologic agents are reassessed every 12 months, to determine whether continuation of therapy is appropriate. Only those with evidence of ongoing active disease, determined by clinical symptoms, biochemical markers, endoscopic or radiological investigations, should continue with therapy. With the increasing use of biologics, this represents a major challenge and may result in biologic agents being inappropriately continued, at significant cost to the NHS. A virtual biologics MDT (VMDT), consisting of 2 IBD consultants and 2 specialist nurses, was launched in 2017 at Russells Hall Hospital (RHH) to address this issue. We aim to evaluate its performance in 2018.
Methods
We performed a retrospective case note review of all patients discussed at the VMDT in 2018. Clinic letters, blood results, endoscopy reports and radiological investigations were examined to determine adherence to NICE guidelines.
Results
Out of a total 223 patients using biologics in 2018, 119 (51.2% male, 79.8% Crohn’s disease, mean age 42.7 years, 57.9% taking adalimumab) were discussed at the VMDT. 67/119 patients were taking a second immunosuppressant agent and out of the remaining 58, 32 had documented evidence of treatment failure or side effects on these agents and 23 were planned to commence them from the MDT. Fourteen patients (11.8%) had their biologic de-escalated post MDT and 5 (4.2%) were switched to a second-line agent. 1 patient’s planned de-escalation was prevented by ankylosing spondylitis. 26/119 patients had no recent or planned radiological or endoscopic reassessment of their disease at 12 months. Of these 26 patients, 17 had ongoing clinical symptoms preventing treatment withdrawal, 2 were de-escalated and 6 had plans to add a second agent prior to reassessment. Only 1 patient continuing treatment had a good indication for de-escalation. Of the 89 patients eligible for therapeutic drug monitoring, 8 were found to have no levels within 12 months of the VMDT (all taking adalimumab). All of these patients were identified at the time and 7 were sent for levels. The remaining patient had their drug discontinued.
Conclusion
The virtual biologics MDT at RHH has been shown to be an effective way of monitoring patients’ disease activity and drug levels, optimising drug therapy and appropriately de-escalating biologic agents. It was only possible to discuss 53.4% of our patients at the virtual MDT and we recommend this service is expanded by allocating a formal monthly session to ensure that all patients can be reviewed. Work is now underway to assess performance in 2019 and follow-up patients who have had their biologics discontinued.