Disease monitoring of biologic treatment in IBD: early impact and future implications of COVID-19 pandemic

Abstract

COVID-19 has dominated life in 2020 with, at the time of writing, over 4.9M global cases and >320 000 deaths. The impact has been most intensely felt in acute and critical care environments. However, with most UK elective work postponed, laboratory testing of faecal calprotectin halted due to potential risk of viral transmission and non-emergency endoscopies and surgeries cancelled, the secondary impact on chronic illnesses such as inflammatory bowel disease (IBD) is becoming apparent. Data from the Scottish Biologic Therapeutic Drug Monitoring (TDM) service shows a dramatic drop in TDM testing since the pandemic onset. April 2020 saw a 75.6% reduction in adalimumab testing and a 36.2% reduction in infliximab testing when compared with February 2020 data, a reduction coinciding with the widespread cancellation of outpatient and elective activity. It is feared that disruption to normal patterns of care and disease monitoring of biologic patients could increase the risk of disease flare and adverse clinical outcomes. Urgent changes in clinical practice have been instigated to mitigate the effects of the pandemic on routine clinical care. Further transformations are needed to maintain safe, effective, patient-centred IBD care in the future.

The impact of the COVID-19 pandemic on medical conditions and medication adherence in people with chronic diseases

“…Worsening in IBD symptoms could be caused by the reduction in therapeutic drug monitoring, widespread cancelation of elective procedures (i.e., endoscopies), and outpatient activity (i.e., infusion centers, clinic appointments). 22 Our study also reported worsening asthma and COPD symptoms, which was supported by the GINA and CAT scores during the pandemic compared to the prepandemic. The impact on asthma and COPD may have been caused by limited access to several diagnosis procedures and reduction in usual medical care.…”

The effects of COVID‐19 on IBD prescribing and service provision in a UK tertiary centre

“…Thus the use of TDM was reduced 26 . This observation has been made elsewhere and if prolonged may have consequences, with the potential for inappropriate dosing, drug toxicity or loss of response 27 . The development of point of care assays 28 and methods for remote TDM (for example, using dried blood spots) 29 may allow us to overcome these new barriers to TDM.…”

Inflammatory bowel disease clinical service recovery during the COVID-19 pandemic

“…POC tests may be suitable for patients living in a remote geographical area or those who wish to minimise contact with healthcare facilities. 36 …”