Impact of a pharmacist‐led thiopurine monitoring service in outpatients with inflammatory bowel disease

• Published in: Internal medicine journal Vol. 53; no. 5; pp. 779 - 786
• Main Authors: Rodda, Sheridan E., Fildes, Karina J., Shelton, Edward, Goldberg, Rimma, Moore, Gregory T.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.05.2023; Wiley Subscription Services, Inc
• Subjects: Ambulatory care; Azathioprine - therapeutic use; drug monitoring; Drug-Related Side Effects and Adverse Reactions - drug therapy; drug‐related side‐effects and adverse reactions; Emergency medical care; Humans; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - drug therapy; Intestine; Medical records; medication adherence; Mercaptopurine - therapeutic use; Outpatients; Patients; Pharmacists; Retrospective Studies; Side effects; medication adherence; inflammatory bowel diseases; pharmacists; drug monitoring; drug-related side-effects and adverse reactions
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.15822

Background 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. Aims To determine the impact of a pharmacist‐led monitoring service in patients with IBD commencing thiopurine therapy managed in the ambulatory care setting. Methods 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. Results 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. Conclusions Pharmacist monitoring of thiopurine therapy initiation in IBD outpatients improves adverse effect monitoring and increases medication persistence.