Introduction Inflammatory bowel disease (IBD) has a prevalence of 400 per 100,000 with approximately 240,000 patient with IBD in UK. It is triggered by a combination of environmental, genetic and immunoregulatory factors including a dysfunctional mucosal immune response. In the last 15 years, the introduction of biologicals has dramatically changed the landscape with improving natural history and outcome of IBD. Many multi-centre trials have confirmed the efficacy of both Infliximab (IFX) and Adalimumab (ADA) in the management of IBD. These drugs are however not without side effects and need close monitoring in specialist IBD clinics. We share our experience from a large-sized DGH [>400,000 population] in Northwest England with a dedicated IBD service and experience in the use of biologicals in IBD patients since 2000.
Methods We interrogated and audited our IBD data base and collected all the patients who were or had been on biologicals. The data goes back to the year 2000.
Results The basic demographics showed total of the 90 patients; 42% female. The mean age was 42.4 (female) vs. 39.3 yrs (male). Age at the time of diagnosis of IBD was 31.1 yrs for females and 32.4 years for males. 53% had crohn’s disease and rest were UC. Patients with UC had higher body weight vs. crohn’s disease with a mean of 76.1 vs. 67.6 kg respectively. 58% had Ileoceacal Crohn’s of which 73% were males. 62.5% of females with UC had pan colitis vs. 42% males. All patients were fully informed and consented prior to the initiation of biological therapy. 89% of the patients were on immunomodulators prior to biological therapy. 93% of the patients with UC were on infliximab with 5% on Adalulimab. 1 pt was on Basiliximab which was changed to infliximab. Those with crohn’s disease, 83% were on Infliximab and 17% on Adalulimab. Infliximab was stopped in 30% due to either no further clinical need or change to Adalulimab and of these 6% due to adverse events. In the ADA group 2% stopped due to lack of clinical inefficacy. The median duration of biologicals was 38.2 months, maximum duration 156 months.
Conclusion In the context of IBD, biological drugs in a dedicated IBD service are highly efficacious. In our centre, paucity of adverse event maybe due to our cohort of patient population with little background incidence of TB. In contrast to the UK IBD audit, we had more usage of biologicals in the context of UC, of which 50% had pan colitis. Our experience shows that a treating IBD effectively and safely requires a dedicated service as outlined in BSG guidelines for IBD, and not necessarily a tertiary care referral!
Disclosure of Interest None Declared.
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