Journal of Medicines Optimisation - Mar 2022

Journal of Medicines Optimisation • Volume 8 • Issue 1 • March 2022 23 Second line biologic therapies in inflammatory bowel disease: are they used according to the agreed pathway? Wilcock M, Roberson L, Bhikha S. Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro Correspondence to: [email protected] Background Inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions that require lifelong medical therapy, with the introduction of biologics representing a significant advance in IBD management. The primary aims of IBD management are to induce and maintain remission, reduce the risk of complications and Abstract Title Second line biologic therapies in inflammatory bowel disease: are they used according to the agreed pathway? Author list Wilcock M, Roberson L, Bhikha S. Introduction Inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions that may be treated with biologics. NICE guidance on IBD, both CD and UC, describes the various treatment options. A locally agreed pathway describes use of standard therapy prior to the use of biologics. It then defaults to biosimilar adalimumab or infliximab as first choice parenteral treatment. Other biologics may be chosen depending on various patient considerations and whether for UC or CD. We aimed to identify whether vedolizumab (one of the more expensive choices) was used as a second line biologic in adult patients with IBD, and to ascertain the reasons for any use earlier in the pathway. Method We identified adult patients prescribed biologic treatment for IBD over a five-month period commencing February 2020. The medical records of any patients commenced on the second line choices of vedolizumab, ustekinumab, tofacitinib were purposefully identified and reviewed. Contact was made with the lead IBD nurse if the records did not provide sufficient explanation for the treatment choice. Results Twenty patients (mean age 45, 50% male) had commenced one of the named biologics. There was one patient on tofacitinib, seven on ustekinumab, and 12 on vedolizumab. Usage of these biologics was as second line in 10 instances, as third line in five instances, as sixth line in one instance, but as first line in four instances. Of these four instances, all vedolizumab, there was evidence of multi-disciplinary team discussion on first line use, and all had a valid reason for using this more expensive biologic. Conclusion From this small-scale study, the choice of biologics for IBD was in accordance with our local guideline in the majority of patients. Where deviation from the guideline occurred, this was justified on clinical grounds. Keywords: Inflammatory bowel disease, biologics, vedolizumab.