P30 Is a virtual pharmacy-led hub and spoke model effective in managing primary biliary cholangitis with obeticholic acid?

BackgroundPrimary Biliary Cholangitis (PBC) is a progressive, autoimmune condition that damages interlobular bile ducts and can lead to end-stage cholestatic liver disease. First line therapy is ursodeoxycholic acid (UDCA) at a dose of 13–15 mg/kg/day. Unfortunately, 20–30% of patients do not demonstrate an adequate response to UDCA and 5–10% do not tolerate it. Obeticholic acid (OCA) is a licensed second-line option approved for use by NHS England where prescribing is restricted to specialist centres, requiring multi-disciplinary team (MDT) approval. As a specialist centre, King’s College Hospital NHS Foundation Trust (KCH) established a hub and spoke model to ensure equity of access to treatment, which is led by the specialist liver pharmacy team.MethodPatients were referred to the KCH PBC MDT using a standardised form emailed to the specialist liver pharmacist. Cases were presented to the MDT and spoke sites were informed of the decision by email. Spoke sites were responsible for monitoring and liaison with KCH. Patients were counselled and consented for homecare supply over the telephone by the specialist pharmacist or specialist pharmacy technician. Spoke site clinicians and patients were advised to contact the liver pharmacy team for further advice or in the case of adverse events. All prescribing was undertaken by the specialist pharmacist, with blood tests and follow up appointments managed by the spoke sites and requested by the hub site when prescribing at 3–6 monthly intervals.ResultsOver 21 months, a total of 98 cases were referred to the PBC MDT at KCH. 56% were recommended to start OCA, 30% to start bezafibrate, 5% were recruited into clinical trials, 2% were recommended no change, 1% was referred for itch advice, 1% was referred for a transplant assessment and 1% was given an alternative diagnosis of ductal plate malformation.Of the 56 patients recommended to start OCA, 5/55 (9%) patients were lost to follow up, 1 patient did not start taking OCA due to side effect concerns, and 1 patient moved abroad. 48 patients started treatment, 38 of which remained on OCA at month 12. 18/38 (49%) patients saw a reduction in ALP to