Introduction 5-aminosalicylic acid (5-ASA) preparations are used to induce and maintain remission in ulcerative colitis (UC). The cost of the recommended maintenance dose for oral 5ASA preparations varies from 86p and 208p per day (MIMMS 2011). Switching to cheaper 5ASAs has been suggested as a possible drug cost saving. The BNF states that preparations are not interchangeable but with little direct evidence to support this statement. The aim of this pilot study is to gain preliminary data on a primary care based 5ASA switching programme.
Methods Salofalk granules (Dr Falk Pharma) and Pentasa (Ferring Pharmaceuticals) were identified as the cheapest 5ASA items prescribed in 31 GP practices. An initial pilot study in one practice revealed that only 5/21 patients responded to a written invitation alone and successfully switched to Salofalk. We therefore developed a managed programme utilising a community based gastroenterology nurse specialist in 4 other practices.
A written invitation detailing the rationale for switching 5-ASA was sent to all appropriate patients who were then phoned a week later. If patients agreed to the switch, the GP surgery was contacted by the Nurse Specialist to change the repeat prescription. Patients were switched to Salofalk in 2 practices and Pentasa in the other 2. GP and hospital records were then examined 6 months post-switch to assess for evidence of patient acceptability and tolerability.
Results 120 patients (56 male, 64 female) with a mean age of 50 years were identified as being on a 5-ASA preparation (oral or topical). 56 (47%) were under either virtual or hospital gastroenterology follow-up. 64 patients with ulcerative colitis were taking oral 5-ASAs. 21 (33%) were already taking Salofalk or Pentasa. Of the remaining 43 patients, 24 (56%) agreed to the switch, 10 (23%) declined, and 9 (21%) did not respond to the invitation or telephone call. Of the 24 patients who agreed to switch, only 17 (71%) completed the process. 15 (88%) remained on the new 5-ASA for at least 6 months, with reasons for discontinuation cited as preference for the previous preparation or diarrhoeal symptoms.
Conclusion Conducting a managed 5ASA switching programme is feasible with 17/43 eligible patients successfully switched with 15/17 continuing on these preparations. Areas for development include following up patients who initially agreed but failed to switch, recording more robustly any flares, involving secondary physicians and assessing adherence and cost savings.
This study provides preliminary evidence to develop a large scale study in this important area.
Disclosure of Interest N. Taylor: None Declared, D. Chan: None Declared, J. Bowey: None Declared, F. Cummings Speaker bureau with: Ferring Pharmaceuticals, Conflict with: Advisory board and educational support Ferring Pharmaceuticals. Educational support: Dr Falk, Warner Chilcott and Shire.