P2657 - Therapeutic Drug Monitoring in a Virtual Inflammatory Bowel Disease Center Serving a Rural Patient Population

Gina Manzi, PharmD¹, Damara Crate, RN¹, Corey Siegel, MD, MS^2
1Dartmouth-Hitchcock Medical Center, Lebanon, NH; ²Dartmouth-Hitchcock Medical Center, Hanover, NH

Introduction: Therapeutic drug monitoring (TDM) is becoming standard of care for the management of patients with inflammatory bowel disease (IBD) receiving biologic medications. However, in practice, optimization of these therapies can often fall short for various reasons. Potential barriers to optimization of biologic dosing using TDM include patient engagement, staff resources to follow-up on action plans, and coordination with local laboratories. In rural settings, these barriers are even more significant due to geography and smaller care teams in rural practices. The aim of this study is to evaluate the feasibility and effectiveness of a TDM program within a Virtual (telemedicine) IBD Center serving a rural patient population.

Methods: A Virtual IBD Center has been developed using a “hub and spoke” model in northern New England with an academic medical center (AMC) serving as the hub and six community gastroenterology practices in Vermont and Maine as the spokes. A TDM program coordinated by an IBD pharmacist and IBD nurse was launched as part of the Center to proactively monitor and adjust biologic dosing. All IBD Center patients receiving infliximab, vedolizumab, ustekinumab, and adalimumab were included. Patients enrolled in the IBD Center already receiving biologics had maintenance drug concentrations assessed and patients newly initiated on biologics were scheduled for testing at a defined period after induction.

Results: The first 50 patients with IBD have been enrolled in the Virtual IBD Center. 72% have Crohn’s disease and 28% have ulcerative colitis (UC). 60% are women and 40% are men with a median age of 49 years (range of 20-81). Without telemedicine, the median driving distance from patients’ homes to the AMC would be 219.5 miles (range 46 to 464 miles). 24 patients are currently receiving biologic therapy and eligible for TDM. 33% of these patients have had drug concentrations drawn, 42% are in the process of coordinating drug concentration testing and 25% of patients are coming due for testing within two months. 62% of patients were within recommended range for their specific therapy and those not within range had their dose optimized.

Discussion: TDM is feasible within a virtual IBD program for patients in rural regions. This requires a team at the Virtual IBD Center working in close partnership with local providers and their patients. Further evaluation is needed to optimize this TDM program and to associate clinical outcomes with TDM.


Disclosures:


Gina Manzi, PharmD¹, Damara Crate, RN¹, Corey Siegel, MD, MS². P2657 - Therapeutic Drug Monitoring in a Virtual Inflammatory Bowel Disease Center Serving a Rural Patient Population, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.