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N807 The use of a pre-screening tool for anti-TNFs in IBD in four North West NHS trusts: a study

Campbell R.*1, Gaskell S.2, Nelson E.3, Bloor R.3, Hocking J.4, Hickey T.4, Geraghty V.5, Hodgins J.5

1Stockport Acute Foundation Trust, Gastroenterology, Stockport, United Kingdom 2Stepping Hill Hospital, Department of Gastroenterology, Stockport, United Kingdom 3Macclesfield District General Hospital, Department of Gastroenterology, Macclesfield, United Kingdom 4Royal Blackburn Hospital, Department of Gastroenterology, Blackburn, United Kingdom 5University Hospital Of South Manchester, Gastroenterology, Manchester, United Kingdom

Background

Inflammatory Bowel disease therapies have continued to evolve following the introduction of anti TNF agents. It is recognised that pre-screening for these therapies varies nationwide, with no standardised requirements evident [1].

The aim of this study is to identify if current pre-screening practice within four independent North West England NHS trusts are in line with the European Crohns and Colitis Organisation (ECCO) consensus [2,3].

Methods

A retrospective multicentre cohort study was conducted examining the aspects of the existing pre-screening tools to determine utilisation in each of the four participating NHS trusts.

Results

Ten patients from each NHS trust (N=40)were included, three out of the four trusts had a pre-existing tool for screening. 62% of patients had Crohns disease with the remaining 38% having ulcerative colitis, there were a greater number of males and the age group 18–35 being the most prevelant. 50% of patients were starting Adalimumab, 40% a biosimilar with the remaining 10% Vedolizumab. Assessing the screening outcomes the study identified, EBV Serology, smear testing and results, vaccination history and skin assessment as areas that were not consistantly reviewed (10–28%). Not all trusts had access to faecal calprotectin but Gamma Interferon with Hepatitis and virology screening were done in 98–100% of cases. The majority of the pre-screening was done by the IBD Nurse Specialist (27/40)with the time to treatment showing that 50% of the patients waited over 14 days to commence therapy although 25% of these patients chose to wait over the 14 days [4].

Figure 1. Results.

Conclusion

The four participating North West NHS Trusts identified the need for a standardised pre-screening tool for Inflammatory bowel disease patients requiring anti TNF therapy. This is necessary to ensure conformation and uniformity locally and nationally. Following the introduction of a standard pre-screening tool across the four sites a further audit in 6 months is anticipated.

References:

[1] Mowat C, Cole A, Windsor AI, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho G, Satsangi J, Bloom S, (2013), Guidelines for the management of inflammatory bowel disease in adults. On behalf of IBD section of the BSG, Gut 60 (5), 571–607

[2] Rahier JF et al, (2009), European evidence based consensus on the prevention diagnosis and management of opportunistic infections in inflammatory bowel disease, Journal of Crohns and Colitis

[3] Travis SPL, Stange EF, Lemann M, Ovesland T, Chowers Y, Forbes A, D'Haans G, Kitis G, Cortot A, Prantera C, Marteau P, Colombel JF, Gionchetti P, Bouchnik Y, Tiret E, Kroesen J, Starlinger M, Mortensen NJ, (2006), European evidence based consensus on the diagnosis and management of Crohns disease: current management, Gut 55 (1), 16–35

[4] Judge C, DeGascan C, Keegan D, Bryne K, Mulcahy HE, Cullen G, Doherty GA, (2013), Optimising screening for opportunistic infection prior to anti TNF therapy, Gut, Supplement 2