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N010 Flowchart-based monitoring of IBD patients on biological treatment

Y. Krogager*, L. Neergaard

Herlev Sygehus, Gastroenterology, Herlev, Denmark


Biological agents have been shown to be an effective, but expensive treatment to induce and maintain clinical remission in patients with IBD, i.e. ulcerative colitis and Crohn's disease.

Biological treatment requires special attention to ensure correct indication, choice of drug and dosage as well as possible concomitant medication with immunomodulators. Accordingly, it is important to monitor patients regularly as regards therapeutic response and development of side effects.

There is increasing, international focus on optimizing the clinical course of IBD patients to ensure objective assessment of clinical activity and achievement of defined treatment goals, such as mucosal healing. This requires regular clinical controls with activity indices, blood tests, stool cultures, cross sectional imaging modalities (MR scanning), and endoscopy. Moreover, the biological treatment must be monitored with trough levels and antibody assessment. Concomitant treatment with thiopurin immunomodulators may also require an individualized approach based on metabolite measurements. Finally, it is also important that patients attending an IBD clinic are monitored closely in a way that allows documentation of whether the standard of care complies with international standards, such as those produced by ECCO and other leading organisations.

To provide an overview on the clinical course during biological treatment that facilitates structured and uniform management of high quality


We have developed a set of flowcharts for structured care of patients on biological treatment. A flowchart is essentially a time line scheme with predefined clinical visits, assessments and examinations based on best practice management. There is a unique flowchart for each of the biological drugs, we use, and each patient will have their own scheme monitoring their clinical course. Each flowchart covers 0-1,5 year of treatment. At present, we have 210 patients on biological treatment in which the flowchart is being gradually implemented.


The project started with a pilot phase and after review and feedback, the charts have subsequently been revised to fit the requirements in clinical practice. We now plan to evaluate the clinical value of this tool by registration of adherence to scheduled tests and examinations, including endoscopy, as well as by questionnaires to physicians, nurse staff and patients.


We have developed and implemented flowcharts that appear to facilitate more uniform management and systematic collection of relevant activity scores, blood tests and examinations during biological treatment in patients with IBD.

This increases quality of care in IBD nursing.