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Title: A virtual clinic increases anti-TNF dose intensification success via a treat-to-target approach compared with standard outpatient care in Crohn's disease.
Austin Authors: Srinivasan, Ashish ;van Langenberg, Daniel R;Little, Robert D;Sparrow, Miles P;De Cruz, Peter P ;Ward, Mark G
Affiliation: Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
Gastroenterology and Hepatology
Issue Date: Jun-2020
Date: 2020-05-07
Publication information: Alimentary Pharmacology & Therapeutics 2020; 51(12): 1342-1352
Abstract: Virtual clinics represent a novel model of care in inflammatory bowel disease. Their effectiveness in promoting high quality use of biologic therapy and facilitating a treat-to-target approach is unknown. To evaluate clinical and process-driven outcomes in a virtual clinic compared to standard outpatient care amongst patients receiving intensified anti-TNF therapy for secondary loss of response. We performed a retrospective multi-centre, parallel, observational cohort study of Crohn's disease patients receiving intensified anti-TNF therapy for secondary loss of response. Objective assessments of disease activity and anti-TNF trough levels at secondary loss of response and during subsequent 6-month semesters, were compared longitudinally between virtual clinic and standard outpatient care cohorts. The primary endpoint was treatment success, with appropriateness of dose intensification, tight disease monitoring and treatment de-escalation representing secondary outcomes. Of 149 patients with similar baseline characteristics, 69 were managed via a virtual clinic and 80 via standard outpatient care. There were higher rates of treatment success in the virtual clinic cohort (60.9 vs 35.0%, P < 0.002). Rates of appropriate dose intensification (82.6% vs 40.0%, P < 0.001), biomarker remission (faecal calprotectin P = 0.002), tight-disease monitoring (84.1% vs 28.8%, P < 0.001) and treatment de-escalation (21.3% vs 10.0%, P = 0.027) also favoured the virtual clinic cohort. This study favoured a virtual clinic-led model-of-care over standard outpatient care in facilitating treatment success as part of an effective treat-to-target approach in Crohn's disease. A virtual clinic model-of-care also improved treatment outcomes and quality of use of intensified anti-TNF therapy through processes that promoted appropriate dose intensification and tight-disease monitoring, while encouraging more frequent dose de-escalation.
DOI: 10.1111/apt.15742
ORCID: 0000-0001-5952-1570
Journal: Alimentary Pharmacology & Therapeutics
PubMed URL: 32379358
Type: Journal Article
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