Introduction While effective, biologics are associated with potentially serious side effects. Data regarding issues such as dose escalation, the use of concomitant immunomodulation (IM) and exit strategies emerge on a regular basis. Accordingly, regular review of patients on biologics is necessary but, due to service limitations, may be difficult. We assessed whether our recently introduced Virtual Biologics Clinic (VBC) was an effective tool in managing these patients.

Methods The VBC is a multidisciplinary meeting comprising 3 Consultant Gastroenterologists, a Clinical Nurse Specialist and a Specialist Pharmacist. It meets weekly for 1 h and reviews the cases of all patients who have received infliximab (IFX) that week and one-eighth of the patients taking adalimumab (ADA) in rotation. It also reviews patients being considered for biologics and ensures that appropriate screening has occurred. We reviewed the results of our VBC for the period May to October 2009 and assessed whether the meeting had resulted in a management-changing decision.

Results 72 patients (35 male, age 32(17-63) (median (range)) with IBD (65 Crohn's, 1 IBDU, 6 OFG) were reviewed 178 times (2(0–5)). At the start of the 6 months, 40 patients were receiving IFX and 17 ADA, for a median of 12 (1–96) months. 15 patients started treatment during the period (13 IFX, 2 ADA). Concomitant IM was used in 48 patients. In the VBC, decisions regarding dose alteration were made on 20 occasions (dose increase 7, decrease 5; interval decrease 3, increase 5). 3 patients were withdrawn from treatment (loss of response-2, trial of withdrawal-1). The biologic was changed in three cases. Endoscopy was requested in nine cases, MRI in 5 and an urgent clinic appointment was made in 19. Referrals to other specialists were made on five occasions. 94 other management decisions were made including decisions regarding the need for concomitant IM (25), optimisation of IM (21), exit strategy (9), treatment of anaemia (9) and adherence issues (4). A total of 159 management decisions were made in 53 patients. In addition, the decision to start biologics was reviewed in 23 cases and agreed in 21, all of whom received appropriate screening.

Conclusion The VBC is an effective forum in which to make management decisions. It prevents unnecessary clinic appointments but ensures that patients receiving biologics are regularly reviewed. Given the limited data regarding, and rapid evolution of, management strategies for patients receiving biologics, individualised rather than protocol-led care is appropriate. The VBC has the advantage over outpatient clinics of ensuring that complex management decisions are reviewed by a mulitdisciplinary team.