Pharmacy Department, Monash Health, Melbourne, Victoria, Australia.
Department of Gastroenterology, Monash Health, Melbourne, Victoria, Australia.
Intern Med J. 2023 May;53(5):779-786. doi: 10.1111/imj.15822. Epub 2022 Sep 6.
Thiopurines are effective therapies for inflammatory bowel disease (IBD); however, treatment comes with safety concerns and adverse effects. Knowledge of the impact of pharmacists performing thiopurine monitoring is limited.
To determine the impact of a pharmacist-led monitoring service in patients with IBD commencing thiopurine therapy managed in the ambulatory care setting.
Patients commencing thiopurine therapy for IBD pre- and post-introduction of a pharmacist-led monitoring intervention were assessed. Pre-intervention patients received standard of care, while the post-intervention cohort was managed by the pharmacist. Data were acquired via retrospective audit of hospital medical records. The primary end-point was the proportion of patients with documented review for thiopurine adverse effects within the initial 3 weeks. Secondary end-points included achievement of therapeutic drug levels, persistence with thiopurine therapy, IBD-related episodes of care and number of outpatient medical reviews.
Pre- and post-intervention cohorts comprised of 37 and 33 patients respectively. Pharmacist intervention increased the proportion of patients with documented monitoring within 3 weeks from 8.1% to 84.8% (P < 0.01). No difference in thiopurine dose optimisation was seen (27% vs 27.3%). Persistence with thiopurine therapy increased from 65.7% to 87.9% (P < 0.03) at 6 months. IBD-related emergency department presentations were not significantly decreased (8.1% vs 3%; P = 0.62). No significant change was observed in hospital admissions (16.2% vs 12.1%; P = 0.74) or outpatient medical reviews.
Pharmacist monitoring of thiopurine therapy initiation in IBD outpatients improves adverse effect monitoring and increases medication persistence.
硫嘌呤类药物是治疗炎症性肠病（IBD）的有效疗法；然而，治疗存在安全性问题和不良反应。药师进行硫嘌呤监测的影响知之甚少。
确定在门诊环境中接受硫嘌呤治疗的 IBD 患者中，由药师主导的监测服务对患者的影响。
评估了开始接受硫嘌呤治疗的 IBD 患者，这些患者在引入药师主导的监测干预措施之前和之后都接受了评估。干预前的患者接受标准护理，而干预后的患者则由药师管理。数据通过回顾性审核医院病历获得。主要终点是在最初 3 周内有记录的硫嘌呤不良反应评估的患者比例。次要终点包括达到治疗药物水平、硫嘌呤治疗的持续时间、IBD 相关护理发作和门诊医疗复查次数。
干预前和干预后的队列分别包括 37 名和 33 名患者。药师干预将有记录监测的患者比例从 8.1%提高到 84.8%（P<0.01）。硫嘌呤剂量优化没有差异（27%与 27.3%）。硫嘌呤治疗的持续时间从 65.7%增加到 87.9%（P<0.03），在 6 个月时。IBD 相关急诊就诊并没有明显减少（8.1%与 3%；P=0.62）。住院率（16.2%与 12.1%；P=0.74）或门诊医疗复查没有显著变化。
药师对 IBD 门诊患者硫嘌呤治疗起始的监测可改善不良反应监测并提高药物依从性。
