P248 Virtual biologics clinic: a streamlined MDT approach to improve IBD care

Abstract

<h3>Introduction</h3> The challenges of IBD patients on biologics include complex decision making, securing funding and logistics of administration. Aim: To assess the impact of a Virtual Biologics Clinic (VBC) on clinical decision making and patient outcome. <h3>Methods</h3> Electronic records of IBD patients at Barnet Hospital were retrospectively reviewed. Patients discussed at VBCs conducted by IBD consultant gastroenterologists, nurses and pharmacists from 09/2019 to 01/2022 were included. <h3>Results</h3> 66 patients were reviewed, 2 excluded due to misdiagnosis and death. 24 patients had UC and 40 Crohn’s disease; 48% were female and median age was 43. Of those with UC, 58% had left sided disease only, 42% had pancolitis. Clinically, 55% had mild to moderate disease and 45% moderate to severe. Of those with Crohn’s, 80% had terminal ileal disease, 63% colonic disease and 30% perianal disease. 43% had stricturing disease and 38% fistulating disease. Clinically, 30% had mild disease, 50% moderate and 20% severe. 80% of all patients used biologics previously with infliximab (63%), adalimumab (49%), vedolizumab (20%) or ustekinimab (12%). Previous treatments also included azathioprine in 67% of patients, mesalazine 25%, 6-mercaptopurine 16%, methotrexate 8%, sulfasalazine 2%, and tofacitinib 2%. At VBC, 67% patients were on biologics: infliximab (20%), adalimumab (19%), vedolizumab (14%), or ustekinimab (14%). 92% of patients on infliximab had drug levels and/or antibodies measured. of those tested, none had positive antibodies. 81% had faecal calprotectin available and 50% of those had results &gt;1000µg/g; 28% had endoscopies of which there was quiescent disease in 6%, mild 22%, moderate 33%, severe 22%, stricturing 11% and suboptimal views 6%. 44% of endoscopies had histology confirming active disease. Reasons for VBC discussion were inadequate disease control (64%), funding review (9%), remission (2%), reactions to biologics (3%), or other (22%). Outcomes from VBC were to switch biologics (23%), continue current treatment (22%), escalate frequency or dose (14%), stop biologics (13%), rediscuss after further investigations (8%), start biologics (6%), re-initiate biologics (5%) or other (9%). 60 VBC outcomes were confirmed as actioned. 1 was not actioned due to patient choice, 2 are pending and 1 patient was uncontactable. At latest follow up 52% showed clinical response or were in remission and 34% were clinically symptomatic. 14% of patients are awaiting follow up. <h3>Conclusions</h3> VBC is an effective resource for clinical decision making in IBD patients requiring biologics. Over half the patients reviewed following VBC showed at least clinical improvement. VBC is a robust approach of ensuring multifaceted management plans are actioned.