Journal of Medicines Optimisation - Mar 2022

Journal of Medicines Optimisation • Volume 8 • Issue 1 • March 2022 25 for the planning and commissioning of healthcare services for their local area. Many CCGs in England use this Blueteq web-based system which allows clinicians to complete an online proforma for patients prescribed a high-cost medicine, such as a biologic, and receive automatic approval for funding if the patient meets all the relevant criteria which normally reflect the NICE TA guidance. This ensures that clinicians receive the approval to treat immediately. The Blueteq system retains, as an audit trail, the request history, including patient name, drug, indication, criteria for use, date of request, requesting clinician, and whether the request was granted or not. This enables CCGs to monitor the use of expensive treatment, so that only treatments prescribed in line with NICE guidelines are reimbursed to the hospital 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. Vedolizumab is currently approved by NICE for moderate-to-severe active CD if anti-TNF treatment has failed, or if anti-TNF agents cannot be tolerated or are contraindicated. 17 For moderate-to- Figure 1. IBD pathway INFLAMMATORY BOWEL DISEASE THERAPY When standard therapy (e.g. 5ASA, thiopurine, methotrexate) is contra-indicated, ineffective or where patient factors require accelerated therapy or a top down approach. ANTI-TNF THERAPY Either infliximab or adalimumab but choice depends on patient factors and whether concomitant thiopurine therapy is appropriate. If monotherapy adalimumab should be first choice. Golimumab can be considered for ulcerative colitis with MDT agreement. Vedolizumab can be considered with MDT agreement if patient factors such as infection risk make first line use of anti-TNF less favourable. 1st Line ULCERATIVE COLITIS Vedolizumab or tofacitinib or ustekinumab. The choice depends on patient factors such as VTE risk. 2nd Line CROHN’S DISEASE Ustekinumab although vedolizumab can be considered dependent on patient factors.

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