Impact of COVID-19 on infliximab prescribing practices in inflammatory bowel disease

PMO-21 Table 1 Oct 19 Nov 19 Dec 19 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20 Jul 20 No. of tests with complete prescribing data 66 67 70 66 72 71 45 55 71 56 No. on CI % of tests 30 38 36 35 33 33 20 31 35 16 45.5% 56.7% 51.4% 53.0% 45.8% 46.5% 44.4% 56.4% 49.3% 28.6% Thiopurine specifically % of tests 24 24 26 24 22 25 17 22 27 14 36.4% 35.8% 37.1% 36.4% 30.6% 35.2% 37.8% 40.0% 38.0% 25.0% Non standard dosing % of tests 33 30 37 37 34 39 19 32 43 28 50.0% 44.8% 52.9% 56.1% 47.2% 54.9% 42.2% 58.2% 60.6% 50.0% Proactive TDM 42 50 39 42 43 48 31 34 40 31 ConclusionsOur data suggests prescribing practices remain largely static. However July 2020’s drop in CI prescribing may be an early indicator of decreased use. The small rise in non-standard dosing may be due to COVID-19 strategies employed to reduce hospital attendances and requires further review. While the nature of our data will not convey the complete COVID-19 impact, it highlights the need for stringent review of post-COVID-19 clinical practices, patient outcomes, and updated clinical guidance as our understanding of the COVID-19 impact on IBD develops.ReferencesShields S, et al. Frontline Gastroenterology Published Online First: 30 September 2020. doi: 10.1136/flgastro-2020-101563Ungaro RC, et al. Gut Published Online First: 20 October 2020. doi: 10.1136/gutjnl-2020-322539

Disease monitoring of biologic treatment in IBD: early impact and future implications of COVID-19 pandemic.

COVID-19 has dominated life in 2020 with, at the time of writing, over 4.9M global cases and >320 000 deaths. The impact has been most intensely felt in acute and critical care environments. However, with most UK elective work postponed, laboratory testing of faecal calprotectin halted due to potential risk of viral transmission and non-emergency endoscopies and surgeries cancelled, the secondary impact on chronic illnesses such as inflammatory bowel disease (IBD) is becoming apparent. Data from the Scottish Biologic Therapeutic Drug Monitoring (TDM) service shows a dramatic drop in TDM testing since the pandemic onset. April 2020 saw a 75.6% reduction in adalimumab testing and a 36.2% reduction in infliximab testing when compared with February 2020 data, a reduction coinciding with the widespread cancellation of outpatient and elective activity. It is feared that disruption to normal patterns of care and disease monitoring of biologic patients could increase the risk of disease flare and adverse clinical outcomes. Urgent changes in clinical practice have been instigated to mitigate the effects of the pandemic on routine clinical care. Further transformations are needed to maintain safe, effective, patient-centred IBD care in the future.