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P571. Changing patients with ulcerative colitis to once daily mesalazine improves outcome and reduces cost in primary and secondary care

H. Prasher1, P. Savania1, R. Jazrawi2, 1Medicines Management Solutions, Leicester, United Kingdom, 2Dr Falk Pharma UK, Bucks, United Kingdom

Background

Oral mesalazine formulations offer similar efficacy and tolerability for acute and maintenance therapy of UC. Therefore the choice of mesalazine is based on other factors such as adherence to therapy and cost. Once daily dosing and reduced pill burden are the best determinants of improved adherence to therapy. Newer mesalazine formulations such as Salofalk Granules have unique release characteristics allowing them to be administered once daily for both acute and maintenance therapy of UC.

Aims: Two pilot studies were carried in UC patients in primary care. The aims were to assess in patients inadequately maintained on mesalazine therapy, the effect of changing to a “Once Daily” oral mesalazine on disease outcome (Pilot study 1), and on outpatient and hospital visits and cost saving (pilot study 2).

Methods

UC patients from 7 general practices covering a population of 103,000 were reviewed by independent clinical pharmacists “Medicines Management Solutions Ltd”.

Disease activity was assessed (Walmsley Index) and following patient and GP consent; eligible patients were switched to a once daily mesalazine (Salofalk Granules 1.5 g/day). A second review after 6 months assessed disease activity, number of visits to hospital and general practice, steroid use and cost of treatment.

Results

In total, 363 UC patients were reviewed, change was recommended in 130 patients (36%) and was actioned in 87 (24%). The main reasons for changing to once daily mesalazine were adherence issues (52%), patient preference (36%) and symptoms (12%). In the first pilot study the second review 6 months later demonstrated that 70% of the patients improved their UC severity score (Walmsley Index) and 30 had no change. There was no worsening of the UC score in any patients. In the second pilot study review after 6 months in patients switched to once daily mesalazine maintenance therapy demonstrated: 47% reduction in all hospital visits, 60% reduction in hospital visits due to flare up of UC, 45% reduction in GP visits and 50% reduction in steroid courses used. The majority of patients preferred once daily dosing and 85% of patients admitted no prior knowledge of the availability of alternative dosing regimes. Both pilot studies demonstrated a substantial cost saving.

Conclusion

Maintenance therapy of UC in the community is inadequate in more than one third of patients. Optimising maintenance therapy by switching to a once daily mesalazine leads to improved patient and disease outcomes as well as cost saving.