P012 Cross-specialty audit of Infliximab prescribing at the Great North Children’s Hospital (GNCH)

Abstract

Abstract Background/Aims Infliximab is an anti-TNF biologic licensed for use in children and young people (CYP) with juvenile idiopathic arthritis (JIA) uncontrolled by methotrexate and children with inflammatory bowel disease uncontrolled by thiopurines. Key side-effects include immunosuppression, neutropenia, liver derangement, latent TB reactivation and risk of anaphylactic reactions. Infliximab is administered intravenously on paediatric day units. Between-specialty inconsistencies complicate the administration and monitoring of infliximab. This retrospective audit aimed to explore adherence to local / national guidance governing Infliximab administration. It is part of an ongoing programme of work towards improved cross-regional quality of care provided to CYP on systemic immunomodulatory therapies. Methods All patients prescribed Infliximab at GNCH in Newcastle between January and December 2020 were identified from pharmacy records. Adherence to local and national guidelines was audited, with particular emphasis on pre-medication investigations, rate of administration, frequency of complications and duration of post-infusion monitoring. Results The rheumatology team at GNCH prescribe infliximab in accordance with local trust guidelines based on BSPAR guidance. The gastroenterology team follow updated ESPGHAN guidelines (European Society for Paediatric Gastroenterology, Hepatology and Nutrition). A total of 155 patients were identified (138 gastroenterology patients and 17 rheumatology patients - 16 JIA, 1 Behcets disease). 17 gastroenterology patients with Crohn’s disease, matched by age, were selected for this audit. Table 1 details audit results for adherence to local/national guidance for Infliximab administration in GNCH. One child with JIA who was non-compliant with second immunosuppressant had an anaphylactic reaction after 5th Infliximab dose. Conclusion Current gastroenterology and rheumatology guidance suggest different pre-screening tests, dose regimens, rates of infusion and duration of post-treatment monitoring. Specialties are not following all guidelines perfectly, in particular pre-treatment viral screening. Although different specialties will continue to require different dosing schedules for infliximab, current practice suggests that it is reasonable to develop cross-specialty guidance governing the prescribing and administration of Infliximab. A cross-specialty guideline will reduce unnecessary variation in practice, reducing the potential for prescribing and administration errors. Disclosure S. Habibollah: None. K. Hartley: None. F. Mcerlane: None.