Category: Federal Forum Posters
Purpose: Due to their action on specific mediators in the immune system, biologic agents are highly utilized in inflammatory diseases such as rheumatoid arthritis, psoriasis, and inflammatory bowel disorder. Immunosuppressive effects help to control symptoms and inflammation, but also elevate risk for infections, virus re-activation, malignancies, and comorbid complications. Therefore, monitoring biologic treatment is vital to ensure safety and effectiveness. Guidance for screening and monitoring across all biologics share similar recommendations, but are not standardized. Additionally, these agents are costly and require thorough consideration prior to use. This medication use evaluation aims to assess current prescribing and monitoring of biologic agents.
Methods: A retrospective chart review will be performed on outpatients prescribed biologic treatment under dermatology, rheumatology, and gastroenterology services at a Veterans Affairs (VA) hospital from September 2017 to 2018. Drugs will include: abatacept, adalimumab, apremilast, certolizumab, dupilumab, etanercept, golimumab, infliximab, ixekizumab, rituximab, secukinumab, toclizumab, tofacitinib, ustekinumab, and vedolizumab. Pharmacy consults, provider documentation, medication histories, and labs will be collected and de-identified for each patient. The following information will be reviewed: gender, pregnancy status, prescribing service, treatment indication, past treatment and pertinent medical history and labs. Relevant clinical data may comprise of comprehensive bloodwork, liver function, inflammatory biomarkers, immunizations, tuberculosis testing, hepatitis B and C screening, and disease severity classification tests. When available, documentation of adverse effects and treatment response will be recorded to evaluate safety and efficacy. Fill histories will determine medication adherence, expressed as medication possession ratio (MPR). Lastly, calculation of drug costs (per 30 days/per patient) will address economic burden. Results shall evaluate compliance to suggested monitoring practices for biologics in accordance to guidelines. Goal outcomes seek to enhance patient safety and the quality of care at a VA facility by educating prescribers and identifying interventions to standardize screening and monitoring for biologic agents.
Results: not applicable
Conclusion: not applicable
Elisa Torres– PGY1 Pharmacy Resident, VA Connecticut Healthcare System, Branford, CT