Download N002 Tolerability of shortened one-hour infliximab infusion times in

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Nurses presentations
The aim of the audit was to quantify Helpline activity: who
calls and why, the amount of time spent on related activity as
well as associated cost benefits and financial consequences of
not having this service.
Methods: A proforma was developed to capture the incoming
telephone calls, this was pioloted at 4 sites with minor
adjustments made prior to the audit. Each participating site
recorded their Telephone Helpline activity on a promorma
during February 2012. This information was entered on to a
central spreadsheet for analysis.
Results: There were a total of 1187 calls (72 289 per site)
recorded over the 28 day period (Table 1).
Table 1. Caller: diagnosis/gender
Crohn’s
Ulcerative Colitis
Indeterminate Colitis
Microscopic Colitis
Unknown
Male
Female
257
218
25
1
14
355
243
45
14
15
The reason for contact was ascertained for all callers, the
majority of contacts were relating to disease management
(44%) with 22% of calls relating to medication, 16% were
administrative 10% of patients were seeking test results and
the remainder (8%) for various reasons.
Follow up: See table 2.
60% of calls lasted <5 minutes, 38% 5 15 minutes, the remainder
>30 minutes. 79% of calls needed <15 minutes follow up activity,
2% needed >30 minutes.
Table 2. Action taken by IBD Nurse following helpline contact
Action
Percentage of contacts
Disease management/advice
Medication information
Administration
Urgent appointment/Admit
Repeat prescription
Results discussed
New/change of treatment
Book tests
Refer to other professionals
Other
18%
15%
15%
10%
8%
7%
7%
6%
6%
5%
UK tariff for ‘non face to face’ consultations is £23.00. Across 9
sites, between 25% and 75% of calls were chargeable, earning
£1012 1932 for this period. Three trusts not charging may have
lost up to £28,000 per year.
Conclusions: IBD Nurse Helplines are a well-used resource,
generating income and achieving cost savings by preventing
out patient /GP appointments and ensuring rapid access to
expert advice & treatment. Helpline activity represents a
significant proportion of IBD nursing time and needs timetabling
accordingly with educational support to ensure a high quality
service. Those not charging might reconsider as monies earned
could be ploughed back into patient care.
Nurses poster presentations
N001
Comparative study of two intravenous iron formulations
in day-hospital: effectiveness, efficiency and security
N. Cano1 *, L. Oltra1 , E. Martín2 , E. Hinojosa1 , J. Hinojosa1 .
1
Manises Hospital, Inflammatory Bowel Disease Unit Day
Hospital, Manises, Spain, 2 University General Hospital,
Valencia, Spain
Background: Iron deficit anemia is a phenomenon usually
related to chronic inflammatory bowel disease. Nowadays,
several pharmacological formulations have been developed to
supply iron deficit, varying in the associated dextran composition. We sought to compare effectiveness, efficiency and
security of two intravenous iron formulations concomitantly
to basis treatment in patients affected of Crohn’s disease and
ulcerative colitis: ferric-carboxymaltose (FC) and ferric-sucrose
(FS).
Methods: 72 patients undergoing intravenous iron treatment
enrolled (June 2011
February 2012). Indications for
iron intravenous treatment: haemoglobin <10 g/dL and/or
ferritin <100 mcg/L. Exclusion criteria: intravenous iron
intolerance and/or undergoing additional oral iron supplementation. Patients undergoing erythropoietin treatment were
not excluded. Blood transfusion was registered but meant
the exclusion of the patient of the follow-up. Protocol of
treatment: Ferric-carboxymaltose (40 patients): 1000 mg in 15
minutes perfusion once a week; ferric-sucrose (32 patients):
200 mg in 2 hours perfusion twice a week. Variables considered:
average haemoglobin, hematocrit, mean corpuscular volume
(MCV), mean corpuscular haemoglobin (MCH), ferritin, number
of dosages, cost of the treatment and tolerance/adverse
events.
Results: There were no significant differences in average levels of haemoblobin (FC 10.78±2.06 mg/dL vs. FS
10.14±2.33 mg/dL), hematocrit (FC 32.15±3.24% vs. FS
30.47±4.53%), MCV (FC 72.40±7.72 fL vs. FS 69.54±8.46 fL) and
MCH (FC 25.43±6.22 pg/dL vs. FS 23.75±5.93 pg/dL). Average
ferritin levels were higher in FC group (264.74±17.83 mcg/L
vs. 179.52±21.36 mcg/L; p = 0.023). Adverse events registered
in the administration of FC were lower (1.44% (2) urticarial reactions) vs. FS (6.10% (23) stomachache/headache); p < 0.001.
2 patients in FC group required blood transfusion vs. 6 patients
in FS group; p = 0.062. The number of administered dosages was
significantly higher in FS group in a ratio FS/FC of 3.39 dosages
per patient. FC application reduced treatment cost in 948.46
euros per patient.
Conclusions: Treatment with intravenous FC for concomitant
treatment of iron deficit anaemia in patients with chronic
inflammatory bowel disease, shows an effectiveness profile not
inferior to FS, with higher increase of ferritin levels and a
better security profile. Related to its posology, FC treatment
shows to improve efficiency reducing dosages, blood transfusion
and costs per patient.
N002
Tolerability of shortened one-hour infliximab infusion times
in IBD patients: a single-center cohort study
L. Guidi1 *, M. Marzo1 , A. Donati1 , S. Ennas1 , D. Pugliese1 ,
C. Felice1 , G. Andrisani1 , I. De Vitis1 , G.L. Rapaccini1 , A. Papa1 ,
A. Armuzzi1 . 1 Internal Medicine and Gastroenterology Unit,
Complesso Integrato Columbus, Catholic University, Rome,
Italy
Background: Infliximab therapy has greatly improved the
management of inflammatory bowel disease (IBD), with efficacy
in inducing and maintaining clinical remission. Infliximab, a
Nurses poster presentations
chimeric monoclonal antibody to tumour necrosis factor alpha,
requires intravenous administration in over 2 hours, with a
further 1 hour of post-infusion observation. We reported our
experience with shortened 1-hour infusions in IBD patients
treated with infliximab with the aim to assess the safety and the
tolerance of an accelerated infusion protocol and the incidence
of possible infusion reactions.
Methods: This was a prospective cohort study on patients with
IBD receiving infliximab with shortened 1-hour infusions. All
patients were treated with scheduled maintenance infliximab
therapy, with at least five well tolerated 2-hours infusions
before enrolment. For each patient we recorded diagnosis,
infusion number and parameters, premedication, concurrent
immunosuppressor therapy, maintenance period of treatment
and adverse events.
Results: Forty-two IBD patients (24 Crohn’s Disease, 18
Ulcerative Colitis) were treated with 1-hour infliximab infusion
protocol at the dose of 5 mg/kg/body weight. Nine out of 42
patients (21.4%) were on concomitant immunosuppressants;
thirty out of 42 patients (71.4%) were on maintenance
biological treatment from more than 1 year. In total, 117
maintenance 1-hour infliximab infusions were administered.
Adverse reactions were reported in 3 out of 117 (2.5%)
1-hour infusions: 2 reactions were considered as mild, allowing
completion of the infusion with the standard 2-hour protocol;
one reaction was considered as severe, resulting in infliximab
discontinuation.
Conclusions: A dedicated IBD infusion unit can achieve a
better quality of care in patients with inflammatory bowel
disease. An accelerated 1-hour infliximab infusion was safe
and well tolerated in our IBD patient cohort under scheduled
maintenance therapy.
N003
Practicalities of varicella screening and vaccination in the
paediatric inflammatory bowel disease (IBD) patients
L. Curtis *, V. Garrick, P. McGrogan, A. Barclay, K. Fraser,
R. Russell. Glasgow Royal Hospital for Sick Children,
Gastroenterology department, Glasgow, United Kingdom
Background: Varicella Zoster Virus (VZV) has been suggested
to cause significant morbidity and mortality to the immunosuppressed child with IBD [1]. Pre-emptive strategies should be
considered for a child with IBD to reduce the impact of the
varicella infection in line with published guidelines [2]. We aim
to describe the impact of our VZV screening and immunisation
programme.
Methods: Universal varicella serology screening was introduced
at the time of IBD diagnosis in our tertiary unit from 2009.
Children identified as VZV negative, were then considered
for vaccination. A two stage varicella vaccination programme
was implemented, using either the Varivax® or the Varilrix®
vaccine, with an interval time of 4wks. For children with
negative serology unsuitable for vaccination, varicella specific
education was delivered to the family by the IBD Nurse.
Median values were compared using a Mann Whitney test
(Minitab v.15).
Results: Between 2009 2011, 136 children were diagnosed with
IBD, 91 (67%) Crohn’s Disease (CD), 30 (22%) Ulcerative Colitis
(UC) and 15 (11%) IBD Unclassified. 6/136 (4.4%) were not tested
for varicella serology. Of the remaining 130 patients, 117 (86%)
were positive and 13 (9.6%) negative. Of the negative patients
10 had CD and 3 UC. Median age of varicella negative patients
was significantly younger than positive patients (8.77 years vs.
12.16 years, p = 0.01). 8/13 (62%) varicella negative patients
were successfully vaccinated. In the children with negative
serology, 5 received Exclusive Enteral Nutrition therapy, of
which 80% were successfully vaccinated. Of the patients
not vaccinated, 4 (80%) were treated with a course of
steroids. There was only one opportunity to vaccinate one
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of these patients post completion of their steroid therapy.
6/8 of patients vaccinated demonstrated sero-conversion post
vaccination. Of the remaining 5 (38%) children who were
not immunised, 2 required post exposure prophylaxis. None
required Varicella, however 7 children with IBD who were
immunosuppressed and diagnosed with IBD prior to 2009,
required treatment for Varicella (5 with IV aciclovir and 2 oral
aciclovir) in the 3yr period.
Conclusions: At diagnosis 10% of newly diagnosed paediatric
patients were found to be VZV negative. Serology negative
patients can be successfully vaccinated. The ability to
vaccinate is dependent on early treatment choices. The IBD
Nurse is identified as having a pivotal role in coordinating
management strategies that may reduce the need for
treatment of varicella infection.
Reference(s)
[1] Roderick M, et al, (2007), Should the UK introduce varicella
vaccine?, Archive disease child, 1051 1052
[2] Rashier J F et al, (2011), The European (ECCO) Consensus
on infection in IBD: what does it change for the clinician?
ECCO, Gut, 1313 5.
N004
Successful, nurse-led, protocol-based, safety monitoring
in IBD patients on thiopurines
J. Hughes1 *, J. Andrews1 , R. Grafton1 . 1 Royal Adelaide
Hospital, Gastroenterology, Adelaide, Australia
Background: Twenty seven percent (219) of our 800 IBD
patients are on current thiopurine therapy.
For optimal safety we recommend regular monitoring of:
• Full blood count and liver enzymes
• Patient compliance and general well-being
With a limited number of medications available for the
treatment of Inflammatory Bowel Disease, it is vital that
maximum benefit is obtained from each medication.
Even with the provision of verbal and written information/instructions, many patients will not adhere to the
schedule of blood testing recommended. The role of monitoring
patients is carried out by IBD nurses at the Royal Adelaide
Hospital, in order to provide an effective, patient-centred
approach.
Methods: When a patient commences a thiopurine, an IBD nurse
is notified. We commence with 50 mg and build up to target
dose based on patient weight, to facilitate early detection of
intolerance and to help minimize side effects. Our regime for
blood testing is:
• weekly until 4 weeks after target dose is reached
• monthly for 3 months
• 3 monthly thereafter.
The nurse follows up all results including those not done
when due, thus avoiding the potential for only observing
compliant/well patients. If the dose is increased at any stage,
weekly testing is resumed for 4 weeks. Contact is made with
the patient each week after receipt/non-receipt of results, for
assessment of wellbeing and instructions on appropriate dose
adjustments.
Results: Overall number monitored during 2012 (all frequencies) 219.
Intolerant/adverse event 51.
“Shunters” commenced on Allopurinol this year 16.
Reminders required (excluding weekly contact with novice
patients) 350. Average/week 9.
Total blood tests reviewed 2012 to date 810. Average/week 20.
Conclusions: The IBD nurse is ideally suited to carry out this
monitoring:
• Able to recognize and reassure re minor side effects
and investigate and implement treatment for major side
effects.