Sharma Esha, Meade Susanna, D'Errico Francesca, Pavlidis Polychronis, Luber Raphael, Zeki Sebastian, Hill Katie, Duff Alexa, O'Hanlon Dearbhaile, Tripoli Sherill, Stanton Anna, Caracostea Andra, Honap Sailish, Reynolds Rebecca, Anderson Simon, Ray Shuvra, Mawdsley Joel, Sanderson Jeremy, Samaan Mark A, Irving Peter M
Inflammatory Bowel Disease Unit Guy's and St Thomas' Hospital London UK.
School of Immunology and Microbial Sciences King's College London London UK.
GastroHep. 2020 Nov;2(6):318-326. doi: 10.1002/ygh2.433. Epub 2020 Dec 5.
To quantify the effects of COVID-19 on our inflammatory bowel disease (IBD) unit, including service provision, prescribing practices and use of therapeutic drug monitoring (TDM).
We performed a single centre retrospective observational cohort study. Data was extracted from our IBD database, electronic patient records and radiology/endoscopy reporting systems between 16/3/20-17/4/20 and the corresponding period in 2019.
A similar number of patients commenced biologic therapy before COVID-19 (n = 37) and during the pandemic (n = 36). Patients in the pre-COVID-19 cohort were older (median 36 vs 29 years, = 0.009) with a longer median disease duration (9.3 vs 5.2 years, = 0.02). During COVID-19 there was a nonsignificant increase in prescribing of vedolizumab (8/37, 22% vs 14/36, 39%, = 0.13) and a higher proportion of patients were anti-TNF-naïve (3/17, 18% vs 18/24, 74%, = 0.0004). There was a reduction in use of concomitant immunomodulators (22/29, 76% vs 4/34, 12%, < 0.0001) and increased biologic use in thiopurine-naïve patients (3/37, 8% vs 15/36, 42%, = 0.001). Use of TDM fell by 75% (240 vs 59 tests). Outpatient appointments fell by 68% and were conducted via telemedicine. MRI scanning, endoscopy, luminal surgery and inpatient numbers fell by 87%, 85%, 100% and 82% respectively. IBD Clinical Nurse Specialist and Pharmacist helpline contacts increased by 76% and 228% respectively.
We observed prescribing differences during COVID-19, bypassing the initiation of immunomodulators and/or anti-TNF therapy in favour of vedolizumab with a reduction in immunomodulator prescribing. We also observed a rapid reorganisation of service provision, including a shift towards telemedicine and online solutions.
量化2019冠状病毒病（COVID-19）对我们炎症性肠病（IBD）科室的影响，包括服务提供、处方实践以及治疗药物监测（TDM）的使用情况。
我们开展了一项单中心回顾性观察队列研究。数据取自我们的IBD数据库、电子病历以及2020年3月16日至4月17日与2019年同期的放射学/内镜检查报告系统。
在COVID-19之前（n = 37）和疫情期间（n = 36）开始生物治疗的患者数量相似。COVID-19之前队列中的患者年龄更大（中位数36岁对29岁，P = 0.009），疾病持续时间中位数更长（9.3年对5.2年，P = 0.02）。在COVID-19期间，维多珠单抗的处方量有不显著增加（8/37，22%对14/36，39%，P = 0.13），且更高比例的患者未接受过抗TNF治疗（3/17，18%对18/24，74%，P = 0.0004）。同时使用免疫调节剂的情况减少（22/29，76%对4/34，12%，P < 0.0001），在未使用硫唑嘌呤的患者中生物制剂的使用增加（3/37，8%对15/36，42%，P = 0.001）。TDM的使用下降了75%（240次对59次检测）。门诊预约减少了68%，且通过远程医疗进行。磁共振成像扫描、内镜检查、腔内手术和住院人数分别下降了87%、85%、100%和82%。IBD临床护士专家和药剂师热线联系分别增加了76%和228%。
我们观察到COVID-19期间的处方差异，绕过免疫调节剂和/或抗TNF治疗的起始，转而使用维多珠单抗，同时免疫调节剂处方减少。我们还观察到服务提供的快速重组，包括向远程医疗和在线解决方案的转变。
