PTU-085 Did the 2010 Nice Guidelines Impact on Biologics Prescription?

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In 2010 NICE updated their guidelines on the prescription of anti-tumour necrosis factor alpha (a-TNF) for Crohn’s disease (CD) to include Adalimumab as a treatment for patients with severe active CD. As a therapeutic option it provided an attractive alternative, both to units, struggling for infusion capacity and limited specialist nurse input, and to patients, as a time-saving, home delivered and administered option.


A retrospective review of inflammatory bowel disease patients at University Hospital North Staffordshire up until December 2012.


Of 3600 inflammatory bowel disease 117 patients are on a-TNF. A further 47 patients have had, but are no longer on, a-TNF. 37 patients had their original a-TNF switched during their disease course (21%). 25 patients (68% of all switches) had their a-TNF switched for non-clinical reasons (*including patient choice and unit preference). All of these were from infliximab to adalimumab, 8 had to be switched back to infliximab.


Prior to switching 23 of the 25 patients were in clinical remission with the other 2 being partial responders. After switching 11 remained in clinical remission, 13 did not have clinical remission and the data was unavailable in 1 patient.


The revision of NICE guidelines to include adalimumab was associated with a significant percentage of *non-clinical switches. There was a 52% loss of efficacy in non-clinical switches. Loss of efficacy when switching has been confirmed in prospective trials.1,2

Disclosure of Interest

None Declared.

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