How can we optimise the management of patients with Inflammatory Bowel Disease?

What is the proposed research question?

Funding

BNSSG ICB Research Capability Funding.

What is the problem?

Inflammatory bowel disease (IBD), Crohn’s Disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions of the intestine affecting 500,000 (1:123) people in the UK. IBD is a lifelong condition, usually diagnosed in young people between the ages of 10 and 30 years old, causing significant disability and often restricting the ability to work normally.

The medical treatment of IBD was revolutionised around 30 years ago with the introduction of the first Biologic therapy, infliximab. Since then, several Biologic and small molecules therapies have been developed for use in IBD.

The increase in options has not been matched by literature to guide doctors in which medications they should use first and how to progress through them in the case of treatment failure. Preliminary data appears to suggest there is significant variation in prescription practices and the current literature does not allow us to optimise outcome by resource utilisation. This delays remission for patients and wastes significant resource.

What is the aim of the research?

To develop a pathway for the prioritisation of Biologic and small molecule therapy for the management of inflammatory bowel disease based on clinical effectiveness, cost effectiveness and patient experience.

How will this be achieved?

First, we will describe the care of inflammatory bowel disease patients across the BNSSG, focusing on local prescribing and variation by area and patient demographic.

Second, we will collect data on clinical outcomes such as blood and stool markers to look for inflammation as well as adverse events, like hospital admissions, steroid courses and surgery. This will be used to compare treatment strategies, providing real-world data to augment what is known about the clinical effectiveness of these drugs in the trial setting.

Third, cost-effectiveness can be assessed by calculating a ‘cost per remission’. For additional context we will include the cost of subsequent emergent clinical contacts for failed therapies and adverse clinical outcomes with each treatment.

Finally, we will use patient interviews to explore patient experience, identify important patient outcomes, and highlight the common difficulties for patients being managed with these medications with a focus on exploring health inequalities.

Who is leading the research?

Dr Jennifer Phillips, Academic Clinical Fellow Gastroenterology.

Further Information:

For more information or to get involved with this project, please contact bnssg.research@nhs.net