Abstract
Background
Tofacitinib is a partially selective Janus kinase inhibitor approved for the treatment of refractory moderate to severe ulcerative colitis UC. We sought to define the ...effectiveness and adverse effects of tofacitinib in a real-world cohort.
Methods
We conducted a retrospective observational cohort study of 134 patients with UC 64% male; median age 37 years range 16–81; 83% of patients had previously received at least one biologic treated with tofacitinib from October 2018 to October 2019 in four UK centres. Disease activity was assessed using the Simple Clinical Colitis Activity Index SCCAI or partial Mayo score PMS, depending on study site. Response and remission were defined as a reduction in SCCAI or PMS of ≥3and SCCAI ≤2 or a PMS ≤1, respectively.
Results
Overall, 74% (88/119; 95 confidence interval CI 65–81% patients responded to tofacitinib at Week 8 and steroid-free remission was observed in 44% 47/108; 95% CI 3453% patients at Week 26. Primary non-response was independently associated with younger age p = 0.014 and higher C-reactive protein CRP levels at baseline p = 0.004. Only 23% 3/13 of patients who continued tofacitinib in the setting of primary non-response were in steroid-free remission at Week 26. Prior biologic exposure did not influence response or remission rates. Dose escalation, however, recaptured response in approximately half of patients who had lost response. Dyslipidaemia was observed in 20% 27/134; 95% CI 1428% of patients, but adverse events necessitating drug withdrawal were uncommon and no venous thromboembolic events occurred.
Conclusions
In this multicentre real-world cohort, tofacitinib was well tolerated and clinically effective in a treatment-refractory UC population.
, Lead Inflammatory Bowel Disease (IBD) Nurse Specialist, Royal Devon and Exeter Hospital, and the Exeter IBD Specialist Nursing Team were runners-up in the Gastrointestinal/IBD Nurse of the Year ...category of the BJN Awards 2021 (vida.cairnes@nhs.net).
We describe the case of a 24 year old male with severe fistulating Crohn's disease who failed mutliple modalities of medical and surgical therapy. We present objective and subjective evidence of ...disease remission after induction and maintenance treatment with leukocyte apheresis. This is the first described case of successful maintenance treatment of severe Crohn's disease with leukocyte apheresis in the United Kingdom.
Summary
Background
Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether ...this meets the needs of patients, as assessed by patients themselves. Aims: To assess patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high‐quality care.
Methods
Using the 2019 IBD standards as a framework, a national benchmarking tool for quality assessment in IBD was developed by IBD UK, comprising a patient survey and service self‐assessment.
Results
134 IBD services and 9757 patients responded. Perceived quality of care was lowest in young adults and increased with age, was higher in males and those >2 years since diagnosis. No hospital services met all the national IBD standards for recommended workforce numbers. Key metrics associated with patient‐reported high‐ quality care were: identification as a tertiary centre, patient information availability, shared decision‐ making, rapid response to contact for advice, access to urgent review, joint medical/surgical clinics, and access to research (all p < 0.001). Higher numbers of IBD nurse specialists in a service was strongly associated with patients receiving regular reviews and having confidence in self‐management and reporting high‐ quality care.
Conclusions
This extensive patient and healthcare provider survey emphasises the importance of aspects of care less often measured by clinicians, such as communication, shared decision‐ making and provision of information. It demonstrates that IBD nurse specialists are crucial to meeting the needs of people living with IBD.
Abstract
Background and Aims
Because of COVID-19 public health restrictions, telemedicine has replaced conventional outpatient follow up for most patients with chronic immune-mediated inflammatory ...disorders treated with biologic drugs. Innovative solutions to facilitate remote therapeutic drug monitoring are therefore required. Low-volume intracapillary blood sampling can be undertaken by patients at home and samples returned by post to central laboratories. We sought to report the effect of the COVID-19 pandemic on requests for therapeutic drug monitoring and the equivalence, acceptability and effectiveness of low volume Patient-led Remote IntraCapillary pharmacoKinetic Sampling fingerPRICKS compared to conventional venepuncture.
Methods
We undertook a cross-sectional blood sampling methods comparison study and compared sample types using linear regression models. Drug and antidrug antibody levels were measured using standard ELISAs. Acceptability was assessed using a purpose-designed questionnaire.
Results
Therapeutic drug monitoring requests for adalimumab (96.5 70.5–106 per week to 52 33.5–57.0, p < 0.001) but not infliximab (184.5 161.2–214.2 to 161 135–197.5, p = 0.34) reduced during the first UK stay-at-home lockdown compared with the preceding 6 months. Fingerprick sampling was equivalent to conventional venepuncture for adalimumab, infliximab, vedolizumab and ustekinumab drug, and anti-adalimumab and anti-infliximab antibody levels. The median interquartile range volume of serum obtained using intracapillary sampling was 195 µL 130–210. More than 87% 90/103 of patients agreed that intracapillary testing was easy and 69% 71/103 preferred it to conventional venepuncture. In routine care, 75.3% 58/77 of patients returned two blood samples within 14 days to permit remote assessment of biologic therapeutic drug monitoring.
Conclusions
Therapeutic drug monitoring can be undertaken using patient-led remote intracapillary blood sampling and has the potential to be a key adjunct to telemedicine in patients with immune-mediated inflammatory diseases.
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