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. 2020 Nov;2(6):318-326.
doi: 10.1002/ygh2.433. Epub 2020 Dec 5.

The effects of COVID-19 on IBD prescribing and service provision in a UK tertiary centre

Esha Sharma  1 , Susanna Meade  1 , Francesca D'Errico  1 , Polychronis Pavlidis  1   2 , Raphael Luber  1 , Sebastian Zeki  1 , Katie Hill  1 , Alexa Duff  1 , Dearbhaile O'Hanlon  1 , Sherill Tripoli  1 , Anna Stanton  1 , Andra Caracostea  1 , Sailish Honap  1 , Rebecca Reynolds  1 , Simon Anderson  1 , Shuvra Ray  1 , Joel Mawdsley  1 , Jeremy Sanderson  1 , Mark A Samaan  1 , Peter M Irving  1   2
Affiliations

The effects of COVID-19 on IBD prescribing and service provision in a UK tertiary centre

Esha Sharma et al. GastroHep. 2020 Nov.

Abstract

Background: To quantify the effects of COVID-19 on our inflammatory bowel disease (IBD) unit, including service provision, prescribing practices and use of therapeutic drug monitoring (TDM).

Methods: We performed a single centre retrospective observational cohort study. Data was extracted from our IBD database, electronic patient records and radiology/endoscopy reporting systems between 16/3/20-17/4/20 and the corresponding period in 2019.

Results: A similar number of patients commenced biologic therapy before COVID-19 (n = 37) and during the pandemic (n = 36). Patients in the pre-COVID-19 cohort were older (median 36 vs 29 years, P = 0.009) with a longer median disease duration (9.3 vs 5.2 years, P = 0.02). During COVID-19 there was a nonsignificant increase in prescribing of vedolizumab (8/37, 22% vs 14/36, 39%, P = 0.13) and a higher proportion of patients were anti-TNF-naïve (3/17, 18% vs 18/24, 74%, P = 0.0004). There was a reduction in use of concomitant immunomodulators (22/29, 76% vs 4/34, 12%, P < 0.0001) and increased biologic use in thiopurine-naïve patients (3/37, 8% vs 15/36, 42%, P = 0.001). Use of TDM fell by 75% (240 vs 59 tests). Outpatient appointments fell by 68% and were conducted via telemedicine. MRI scanning, endoscopy, luminal surgery and inpatient numbers fell by 87%, 85%, 100% and 82% respectively. IBD Clinical Nurse Specialist and Pharmacist helpline contacts increased by 76% and 228% respectively.

Conclusions: We observed prescribing differences during COVID-19, bypassing the initiation of immunomodulators and/or anti-TNF therapy in favour of vedolizumab with a reduction in immunomodulator prescribing. We also observed a rapid reorganisation of service provision, including a shift towards telemedicine and online solutions.

Keywords: biologics; immunosuppression; inflammatory bowel disease.

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Figures

Figure 1
Figure 1
Proportion of patients who were anti‐TNF or thiopurine naïve on commencement of biological therapy before and during the COVID‐19 pandemic
Figure 2
Figure 2
Service provision: Graph showing the number of patient contacts before and during the pandemic with regards to clinic (face to face or telephone), IBD infusion unit attendance and helpline contacts
See this image and copyright information in PMC

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