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National clinical audit of biological therapies – Annual report 2016

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The purpose of National clinical audit of biological therapies – Annual report 2016 is to measure the efficacy, safety and appropriate use of biological therapies in patients with IBD in the UK. The audit also aims to capture patients’ views on their quality of life at intervals during their treatment. This is the fifth report of the biological therapy element of the UK IBD audit; all analyses within this report include only those patients who were newly started on biological therapies between 12 September 2011 (the start of data collection) and 29 February 2016. The data contained within this report have only been taken from completed submissions within the biological therapy audit web tool.

Key recommendations

  • Clinicians should use infliximab biosimilars as the first line anti-TNFα for appropriate patients with active IBD.
  • Clinicians should completely screen all patients prior to treatment with biological therapies. Adult patients must have a chest X-ray and screening for TB (Gamma interferon or a Mantoux screen), as well as hepatitis B, hepatitis C and HIV. Paediatric patients must have a chest X-ray and screening for hepatitis B and TB (Gamma interferon or a Mantoux).
  • Clinicians should document follow-up in all patients within 3 months and at 1 year following initial treatment with biologics. A disease activity index should also be recorded in all patients at baseline, 3 months and 1 year as a minimum. These steps will ensure that only appropriately responding patients continue to have treatment.
  • Steroid use in all patients should be kept to a minimum. Infliximab has a steroid sparing effect and steroids should be stopped at the first opportunity.
  • Clinicians should audit all patients on biological therapies to ensure their safe and appropriate use. Data can also be provided to studies such as PANTs5 for research. The UK IBD Registry can be used as a mechanism to keep a register of this information, comparing local to national outcomes and supporting audit and quality improvement.
  • Clinicians should share findings and recommendations of this report at relevant multidisciplinary team, clinical governance and audit meetings, with the aim of developing a local action plan for implementing improvement.