Patient Characteristics, Treatments, And Health Outcomes Over 6 Months In Patients With Inflammatory Bowel Disease Treated In Community Practice Using A Specialized Pharmacy Team

INTRODUCTION: The treatment of inflammatory bowel disease (IBD) is complex and often times requires the long-term use of biologic/small molecule therapy. The prior authorization process for biologic/small molecule therapy is complicated and may result in delayed delivery of necessary therapy. This registry assesses the impact of patient demographics on health outcomes, the medication approval process and compliance in patients with IBD in community GI practices that use a dedicated pharmacy team with expertise in the prior authorization process. METHODS: This IRB-approved, ongoing, observational registry captures long-term health outcomes, patient management and pharmacy support data every 6 months for up to 10 years. Patients are >10 yo, have IBD and are already receiving or newly starting subcutaneous biologic therapy or tofacitinib. A dedicated pharmacy team is responsible for processing all prior authorizations. Pharmacy data is collected from the pharmacy team and clinical data is collected from the community site every 6 months. RESULTS: There were 164 patients enrolled in the registry between March 2018-November 2019. Two-thirds of patients had Crohn's disease (CD) and one-third had ulcerative colitis (UC). The table reports baseline demographics, IBD therapies previously taken as well as those used at the time of registry entry. Of note, steroids were more commonly used to manage patients with UC vs CD (P = 0.014), a higher percentage of Hispanic patients had UC (P = 0.012) and more CD patients had previous IBD-related surgeries (P = 0.00001). At the time of registry entry, 95.2% of biologic/small molecule prescriptions were accepted with the first prior authorization request and nearly two-thirds of patients started treatment <20 days from prescription. After 6 months, 83.6% of patients were considered stable compared to baseline, 6.2% had improved and 10.3% had worsened. During that same time, 3.5% of patients were hospitalized (80% IBD-related). IBD medications remained the same for 88.5% of patients but were changed for some due to inadequate response (5.1%), intolerance (3.2%) or other reasons (3.2%). CONCLUSION: Patients with IBD who are managed at community sites with the support of a specialized pharmacy team can receive biologic/small molecule therapy in an expedited manner. Comparisons of regional differences and longer-term health outcomes will be performed as additional patients are enrolled and the registry progresses.Table 1.: Baseline Characteristics, Previous and Current IBD Medications