Managing an IBD Infusion Unit During the COVID-19 Pandemic: Service Modifications and the Patient Perspective

Clough, Jennifer; Hill, Katie; Duff, Alexa; Sharma, Esha; Ray, Shuvra; Mawdsley, Joel; Anderson, Simon; Irving, Peter M; Samaan, Mark A

doi:10.1093/ibd/izaa171

Cited by 10 publications

(7 citation statements)

References 1 publication

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“…Perhaps surprisingly, there was no association between the use of drugs that impact the immune system and psychological outcomes. These findings are congruent with a recent survey of IBD patients attending our infusion unit for biologic medications in which almost 60% expressed no or minimal concern with respect to their risk of being on medication 31 . While we acknowledge that this is a self‐selecting group who felt comfortable in attending the unit, another study reported only 42% of IBD patients expressed concern about the impact of their medications on COVID‐19 32 .…”

Section: Discussionsupporting

confidence: 87%

Depression, anxiety, and stress among inflammatory bowel disease patients during COVID‐19: A UK cohort study

et al. 2022

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Background and Aim Patients with chronic diseases are believed to be at increased risk of mental health conditions during the COVID‐19 pandemic. We aimed to assess the incidence of psychological morbidity in inflammatory bowel disease (IBD) patients during the COVID‐19 pandemic, explore for association with risk of severe COVID‐19 and other factors, and establish patients' interest in psychological support. Methods A survey including the Patient Health Questionnaire‐9, General Anxiety Disorder‐7, and Perceived Stress Scale tools for depression, anxiety, and stress was administered to IBD patients from a tertiary center in London, United Kingdom, in June 2020. Results Two hundred seventy‐four patients responded to the survey (57% response rate), with 271 (99%) completing it. Moderate–severe depression was observed in 61 (22.5%), while 49 (18%) had moderate–severe anxiety; 39 (14%) had both diagnoses. Mean (SD) stress score was 16.2 (7.4). There was no association between degree of severe COVID‐19 risk and psychological morbidity. Flare symptoms and fatigue were associated with worse psychological morbidity, while accessibility of information regarding COVID‐19 risk and reducing that risk was protective for depression (odds ratio [OR] 0.56 [0.33–0.94], P = 0.03), anxiety (OR 0.62 [0.4–0.96], P = 0.03), and stress (standardized β‐coefficient −0.15 [−0.28 to −0.03], P = 0.02). Seventy‐nine (30%) respondents were interested in receiving psychological support during the pandemic, while 200 (76%) expressed interest beyond the pandemic. Conclusions Although depression, anxiety, and stress among IBD patients during the pandemic were common, their frequency was similar to pre‐pandemic rates and recent general population levels. Ensuring easy access to personalized risk information with targeted psychological support may mitigate psychological burden as patients reintegrate into society and deal with future COVID‐19 waves.

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Section: Discussionsupporting

confidence: 87%

Depression, anxiety, and stress among inflammatory bowel disease patients during COVID‐19: A UK cohort study

et al. 2022

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“…In comparison to intravenous therapy, de-centralising care provision may allow greater patient flexibility, convenience and a range of individual and macroeconomic healthcare benefits [ 31 , 32 , 33 , 34 , 35 ]. The COVID-19 pandemic highlighted the advantages of transitioning care away from the hospital setting [ 36 ]. In this context, a number of guidelines have suggested considering the prioritisation of subcutaneous biologics in IBD management [ 37 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Drug Monitoring of Subcutaneous Infliximab in Inflammatory Bowel Disease—Understanding Pharmacokinetics and Exposure Response Relationships in a New Era of Subcutaneous Biologics

Little

Ward

Wright

et al. 2022

JCM

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CT-P13 is the first subcutaneous infliximab molecule approved for the management of inflammatory bowel disease (IBD). Compared to intravenous therapy, SC infliximab offers a range of practical, micro- and macroeconomic advantages. Data from the rheumatological literature suggest that subcutaneous CT-P13 may lead to superior disease outcomes in comparison to intravenous infliximab. Existing studies in IBD have focussed on pharmacokinetic comparisons and are inadequately powered to evaluate efficacy and safety differences between the two modes of administration. However, emerging clinical trial and real-world data support comparable clinical, biochemical, endoscopic and safety outcomes between subcutaneous and intravenous infliximab in both luminal Crohn’s disease and ulcerative colitis. Across the available data, subcutaneous CT-P13 provides relative pharmacokinetic stability and higher trough drug levels when compared to intravenous administration. The clinical impact of this observation on immunogenicity and treatment persistence is yet to be determined. Trough levels between the two methods of administration should not be compared in isolation as any subcutaneous advantage must be considered in the context of comparable total drug exposure and the theoretical disadvantage of lower peak concentrations compared to intravenous therapy. Furthermore, target drug levels for subcutaneous CT-P13 associated with remission are not known. In this review, we present the available literature surrounding the pharmacokinetics of subcutaneous CT-P13 in the context of therapeutic drug monitoring and highlight the potential significance of these observations on the clinical management of patients with IBD.

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“…Healthcare providers adopted and modified their IBD unit protocols to minimise both patient-patient and patient-health care worker contact. Centres also screened patients for COVID-19 symptoms before they attended infusion units[ 62 ]. A significant proportion of new IBD patients were diagnosed and treated without having endoscopic or histological evaluation[ 63 ].…”

Section: The Effect Of Covid-19 On Gastroenterology and Hepatology Servicesmentioning

confidence: 99%

COVID-19: Effect on gastroenterology and hepatology service provision and training: Lessons learnt and planning for the future

Anjum¹,

Chalmers²,

Hamid³

et al. 2021

WJG

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In late 2019, reports arose of a new respiratory disease in China, identified as a novel coronavirus, severe acute respiratory syndrome coronavirus 2. The World Health Organisation named the disease caused by the virus ‘coronavirus disease 2019 (COVID-19)’. It was declared a pandemic in early 2020, after the disease rapidly spread across the world. COVID-19 has not only resulted in substantial morbidity and mortality but also significantly impacted healthcare service provision and training across all medical specialties with gastroenterology and Hepatology services being no exception. Internationally, most, if not all ‘non-urgent’ services have been placed on hold during surges of infections. As a result there have been delayed diagnoses, procedures, and surgeries which will undoubtedly result in increased morbidity and mortality. Outpatient services have been converted to remote consultations where possible in many countries. Trainees have been redeployed to help care for COVID-19 patients in other settings, resulting in disruption to their training - particularly endoscopy and outpatient clinics. This has led to significant anxiety amongst trainees, and risks prolongation of training. It is of the utmost importance to develop strategies that continue to support COVID-19-related service provision, whilst also supporting existing and future gastroenterology and Hepatology services and training. Changes to healthcare provision during the pandemic have generated new and improved frameworks of service and training delivery, which can be adopted in the post-COVID-19 world, leading to enhanced patient care.

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Managing an IBD Infusion Unit During the COVID-19 Pandemic: Service Modifications and the Patient Perspective

Cited by 10 publications

References 1 publication

Depression, anxiety, and stress among inflammatory bowel disease patients during COVID‐19: A UK cohort study

Depression, anxiety, and stress among inflammatory bowel disease patients during COVID‐19: A UK cohort study

Therapeutic Drug Monitoring of Subcutaneous Infliximab in Inflammatory Bowel Disease—Understanding Pharmacokinetics and Exposure Response Relationships in a New Era of Subcutaneous Biologics

COVID-19: Effect on gastroenterology and hepatology service provision and training: Lessons learnt and planning for the future

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