A virtual clinic increases anti-TNF dose intensification success via a treat-to-target approach compared with standard outpatient care in Crohn's disease
Open Access
- 1 June 2020
- journal article
- research article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 51 (12), 1342-1352
- https://doi.org/10.1111/apt.15742
Abstract
Background Virtual clinics represent a novel model of care in inflammatory bowel disease. Their effectiveness in promoting high quality use of biologic therapy and facilitating a treat-to-target approach is unknown. Aim To evaluate clinical and process-driven outcomes in a virtual clinic compared to standard outpatient care amongst patients receiving intensified anti-TNF therapy for secondary loss of response. Methods We performed a retrospective multi-centre, parallel, observational cohort study of Crohn's disease patients receiving intensified anti-TNF therapy for secondary loss of response. Objective assessments of disease activity and anti-TNF trough levels at secondary loss of response and during subsequent 6-month semesters, were compared longitudinally between virtual clinic and standard outpatient care cohorts. The primary endpoint was treatment success, with appropriateness of dose intensification, tight disease monitoring and treatment de-escalation representing secondary outcomes. Results Of 149 patients with similar baseline characteristics, 69 were managed via a virtual clinic and 80 via standard outpatient care. There were higher rates of treatment success in the virtual clinic cohort (60.9 vs 35.0%, P < 0.002). Rates of appropriate dose intensification (82.6% vs 40.0%, P < 0.001), biomarker remission (faecal calprotectin P = 0.002), tight-disease monitoring (84.1% vs 28.8%, P < 0.001) and treatment de-escalation (21.3% vs 10.0%, P = 0.027) also favoured the virtual clinic cohort. Conclusion This study favoured a virtual clinic-led model-of-care over standard outpatient care in facilitating treatment success as part of an effective treat-to-target approach in Crohn's disease. A virtual clinic model-of-care also improved treatment outcomes and quality of use of intensified anti-TNF therapy through processes that promoted appropriate dose intensification and tight-disease monitoring, while encouraging more frequent dose de-escalation.Funding Information
- Ferring
This publication has 25 references indexed in Scilit:
- Outpatient Ulcerative Colitis Primary Anti-TNF Responders Receiving Adalimumab or Infliximab Maintenance Therapy Have Similar Rates of Secondary Loss of ResponseJournal of Clinical Gastroenterology, 2015
- First trough level of infliximab at week 2 predicts future outcomes of induction therapy in ulcerative colitis—results from a multicenter prospective randomized controlled trial and its post hoc analysisThe Esophagus, 2015
- Trough Concentrations of Infliximab Guide Dosing for Patients With Inflammatory Bowel DiseaseGastroenterology, 2015
- Treat to Target: A Proposed New Paradigm for the Management of Crohn's DiseaseClinical Gastroenterology and Hepatology, 2015
- The relationship between infliximab concentrations, antibodies to infliximab and disease activity in Crohn's diseaseGut, 2014
- Development of an Algorithm Incorporating Pharmacokinetics of Adalimumab in Inflammatory Bowel DiseasesThe American Journal of Gastroenterology, 2014
- Levels of Drug and Antidrug Antibodies Are Associated With Outcome of Interventions After Loss of Response to Infliximab or AdalimumabClinical Gastroenterology and Hepatology, 2014
- Review article: loss of response to anti-TNF treatments in Crohn’s diseaseAlimentary Pharmacology & Therapeutics, 2011
- Trough serum infliximab: a predictive factor of clinical outcome for infliximab treatment in acute ulcerative colitisGut, 2009
- Association of Trough Serum Infliximab to Clinical Outcome After Scheduled Maintenance Treatment for Crohn’s DiseaseClinical Gastroenterology and Hepatology, 2006