P130 Virtual biologics and immunomodulator clinic (VBIC): a review of activity in a tertiary IBD centre

IntroductionWhilst effective in the management of IBD, biologics require regular monitoring and review to address issues such as dose optimisation, switch or withdrawal of treatment, combination with immunomodulators and side effects. This is performed in our multidisciplinary virtual biologics and immunomodulator clinic (VBIC). The aim was to assess the activity of the VBIC and the usage of biologics and small molecules at our Trust, which has clear implications for clinician workload and patient care.MethodsThe VBIC takes place weekly for 3 hours and is attended by IBD Physicians, IBD nurse specialists and an IBD pharmacist, with the outcomes recorded electronically. This was a retrospective study of the electronic records, reviewing the number of patients discussed during the period from November 2018 to May 2022. The number of biologics (Infliximab, Adalimumab, Vedolizumab, Ustekinumab) and small molecules (Tofacitinib) prescribed between 2018 and 2022 was obtained from local pharmacy data.Results7332 patient cases were reviewed in VBIC over the study period. The mean number of patients reviewed per month were 23, 74, 169, 265 and 239 in 2018, 2019, 2020, 2021 and 2022 respectively, with a monthly maximum of 457 in September 2020. The mean number of patients reviewed per month per Consultant were 5, 23, 41, 76 and 81 in 2018, 2019, 2020, 2021 and 2022 respectively. The mean monthly number of biologics and small molecules prescribed in 2018 was 88 and this increased to 518 in 2022.ConclusionsThere was a general increase in the VBIC activity during the study period with a near 12-fold increase in the mean monthly number of patients per Consultant. This is likely to have largely been driven by the increase in the number of patients treated with biologic or small molecule therapies over this time. There are an ever increasing number of treatments being approved for use in IBD and many more emerging therapies in the pipeline. With these and the adoption of cost-saving biosimilars the use of biologics and small molecules is likely to continue on an upward trajectory. Other factors such as earlier, aggressive therapy to achieve mucosal healing and the potential of proactive therapeutic drug monitoring and dose optimisation are also likely to increase the VBIC activity in the coming years. Whilst this is no doubt beneficial for our patients, we must be mindful of the impact on clinicians. Whilst the VBIC activity increased over the study period the clinical ti