THE ROLE OF A SPECIALIST PHARMACIST IN THE MANAGEMENT OF ADALIMUMAB IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Keywords:Pharmacist, Medication, Inflammatory bowel disease
Objective: The management of inflammatory bowel disease (IBD) patients on complex medications such as biologic disease-modifying anti-rheumatic drugs (DMARD) requires close supervision. At East Sussex NHS Healthcare Trust (ESHT), the multi-disciplinary team (MDT) already looking after these patients could benefit from the additional knowledge and support from a specialist pharmacist (SP).
Methods: To assess if the MDT could benefit from an SP, all IBD patients on the DMARD adalimumab were identified. The patient records were screened for patient demographic data, clinical assessment and investigations, treatment, and follow-up clinics.
Results: 162 patients at ESHT were identified as being on adalimumab treatment for either Crohn’s Disease (77%) or Ulcerative Colitis (23%). Disease activity scores, a clinical measure of IBD severity, were infrequently recorded (1%) on patient letters. Evidence of a biologic screen, a series of investigations to ensure safety in a biologic treatment, was only evident in one-third of patients. Clinic review of patients recently started on adalimumab and annual review of stable patients occurred 43% and 26% respectively.
Conclusion: The results indicate that there is a need for an additional member to support the IBD MDT in managing this cohort of patients. An SP is uniquely positioned to fill this gap. They have extensive knowledge in drug indication, therapeutic drug monitoring, and side-effect profiles. Similar studies have been identified that support SP in this role.
Baqir W. Helping to unlock resources: the changing role of the pharmacist; 2015. Available from: https://www.health.org.uk/ blogs/helping-to-unlock-resources-the-changing-role-of-the-pharmacist. [Last accessed on 24 Feb 2021]
Cross VJ, Parker JT, Law Min M-CYLL, Bourne RS. Pharmacist prescribing in critical care: an evaluation of the introduction of pharmacist prescribing in a single large UK teaching hospital. Eur J Hosp Pharm. 2018;25(e1):e2-6. doi: 10.1136/ejhpharm-2017-001267, PMID 31157059.
Walter C, Mellor JD, Rice C, Kirsa S, Ball D, Duffy M, Herschtal A, Mileshkin L. Impact of a specialist clinical cancer pharmacist at a multidisciplinary lung cancer clinic. Asia Pac J Clin Oncol. 2016;12(3):e367-74. doi: 10.1111/ajco.12267, PMID 25227909.
Mikolas LA, Jacques K, Huq M, Krasner C, Mambourg SE. Utilizing clinical pharmacist specialists to manage hepatitis C virus patients on direct-acting antiviral therapy. J Pharm Pract. 2019;32(6):655-63. doi: 10.1177/0897190018777345, PMID 29783912.
Royal Pharmaceutical Society. Pharmacist independent prescribers; 2018.
Pasvol TJ, Horsfall L, Bloom S, Segal AW, Sabin C, Field N, Rait G. Incidence and prevalence of inflammatory bowel disease in UK primary care: a population-based cohort study. BMJ Open. 2020;10(7):e036584. doi: 10.1136/bmjopen-2019-036584, PMID 32690524.
Sairenji T, Collins KL, Evans DV. An update on inflammatory bowel disease. Prim Care. 2017;44(4):673-92. doi: 10.1016/j.pop.2017.07.010, PMID 29132528.
Jeong DY, Kim S, Son MJ, Son CY, Kim JY, Kronbichler A, Lee KH, Shin JI. Induction and maintenance treatment of inflammatory bowel disease: a comprehensive review. Autoimmun Rev. 2019;18(5):439-54. doi: 10.1016/j.autrev.2019.03.002, PMID 30844556.
National Institute for Health and Care Excellence. Infliximab and adalimumab for the treatment of Crohn’s disease; 2010. Available from: https://www.nice.org.uk/guidance/ta187/chapter/1-Guidance. [Last accessed on 28 Feb 2021].
National Institute for Health and Care Excellence. Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy; 2015. Available from: https://www.nice.org.uk/guidance/ta329. [Last accessed on 28 Feb 2021]
Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, IBD guidelines eDelphi consensus group, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British society of gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1-s106. doi: 10.1136/gutjnl-2019-318484, PMID 31562236.
Levin AD, Wildenberg ME, van den Brink GR. Mechanism of action of anti-TNF therapy in inflammatory bowel disease. J Crohns Colitis. 2016;10(8):989-97. doi: 10.1093/ecco-jcc/jjw053, PMID 26896086.
Blueteq Ltd. Trust HCD IFR System. Available from: http://www.blueteq.com.Systems/Trust-HCD-IFR-System.html. [Last accessed on 28 Feb 2021]
Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041-8. doi: 10.1136/bmj.2.4947.1041, PMID 13260656.
Harvey RF, Bradshaw JM. A simple index of Crohn’s disease activity. Lancet. 1980;1(8167):514. doi: 10.1016/s0140-6736(80)92767-1, PMID 6102236.
National Institute for Health and Care Excellence. Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. Nice; 2013. Available from: https://www.nice.org.uk/ guidance/dg11/chapter/1-Recommendations. [Last accessed on 28 Feb 2021]
Hackett M. Handbook for home care services in England; 2014.
Burmester GR, Panaccione R, Gordon KB, McIlraith MJ, Lacerda APM. Adalimumab: long-term safety in 23 458 patients from global clinical trials in rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and Crohn’s disease. Ann Rheum Dis. 2013;72(4):517-24. doi: 10.1136/annrheumdis-2011-201244, PMID 22562972.
Lumbantobing R, Sauriasari R, Andrajati R. Role of pharmacists in reducing drug-related problems in hemodialysis outpatients. Asian J Pharm Clin Res. 2017;10(17):108-13. doi: 10.22159/ajpcr.2017.v10s5.23110.
Jones A, Smith M. Embedding pharmaceutical care into the multidisciplinary team. Brighton and Sussex Hospitals NHS Trust; 2014.
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