OA24 Annual prescribing of biologic agents: a six-month audit of implementation and safety at Guy’s and St Thomas’ Rheumatology

Abstract Background/Aims Current BSR guidance is that all regular-risk patients on biologic disease modifying anti-rheumatic drugs (bDMARDs) should be reviewed at least 6-monthly. Historically prescriptions were generated 6-monthly. Guidelines acknowledge limited evidence for optimal monitoring of patients on biologics, with blood abnormalities uncommon and rarely leading to therapy change. Past audits of bDMARD prescribing between 2017 and 2022 found: the number of individual bDMARD prescriptions increased by 76% (5242/year to 9265/year). Blood dyscrasia and liver dysfunction were rare causes for bDMARD discontinuation (0.98% and 0.65%, respectively).The increased volume of bDMARD prescribing has had a significant impact on resource utilisation within the service. A locally approved clinical guideline was devised to move suitable patients from a 6-monthly to an annual bDMARD prescription schedule. We evaluated the uptake and safety of annual prescribing within the first 6 months of guidance adoption. Methods All patients prescribed subcutaneous bDMARDs (excluding IL6 inhibitors) between 1/2/24 and 31/7/24 were identified using EPIC electronic health records. We compared patients who switched to annual prescribing with those who remained on 6-monthly prescribing. The number of contacts with the rheumatology service were calculated (the number of clinic appointments, phlebotomy appointments, helpline or email interactions and flares). For patients not on annual prescribing, eligibility criteria were reviewed and reasons for not switching documented. Results 644 patients were eligible for annual prescribing. 233 (36.2%) patients were switched to annual prescribing in this period. Neither the biologic drug’s mechanism of action, nor disease indication influenced prescribing decisions. Of those who switched, most patients needed only one clinical review (n = 122, 52.3%) and one blood test (n = 133, 57.1%). 6 patients (6/233; 2.6%) flared and only 1 patient (1/233; 0.43%) had a significant blood test derangement. Patients on annual prescribing had fewer clinical contacts and fewer repeated blood tests than those not on annual prescribing (1 appointment: 7.7% v 28.7%; 1 blood test 20% v 36.9%). 177 (43.1%) met inclusion criteria but were not switched. Conclusion Annual prescribing appeared safe, with no excess of flares or blood-test abnormalities when compared with standard practice. Most patients required only a single clinic review and blood test in the study period. Further work is required to switch all eligible patients to an annual prescribing programme. Annual prescribing reduces clinical contacts and investigations, offering significant lower departmental resource utilisation and potential efficiency savings for rheumatology services nationally. Disclosure T. Igel: Grants/research support; Australian Rheumatology Association; Avant Insurance. G. Sukhija: None. M. Gibson: None. S. Mercer: None. A. Arranz: None. L. Harper: None. B. Menon: None. S. Subesinghe: None.