BI42 Biologic agent patient screening and monitoring practices among Irish dermatologists, rheumatologists and gastroenterologists
Authors: Rory Barry, Richard Watchorn
Journal: British Journal of Dermatology (2024)

Abstract Separate biologic therapy clinical practice guidelines are published by national dermatology, rheumatology and gastroenterology societies. While the same biologic agents may be indicated for multiple diseases, risk vs. benefit considerations, urgency of initiation and specialist comfort in biologic prescribing can vary substantially. To gain insight into specialist biologic prescribing practices, a questionnaire was disseminated via electronic mailing lists to practising consultant members of the national dermatology, rheumatology and gastroenterology societies in Ireland. Overall, 67 questionnaires were completed: 42% of respondents were dermatologists (n = 28), 37% were rheumatologists (n = 25) and 21% were gastroenterologists (n = 14). Overall, 56% (14 of 25) of rheumatologists reported seeing over 20 patients per week on biologic agents, compared with 11% (3 of 28) of dermatologists and 0% (0 of 14) of gastroenterologists. Regarding prebiologic therapy screening, all respondents reported always performing an interferon-γ release assay (IGRA). A lower proportion of dermatologists (61%, 17 of 28) perform a chest X-ray (CXR) than gastroenterologists (92%, 13 of 14) or rheumatologists (84%, 21 of 25; P &amp;lt; 0.05). The British Association of Dermatologists guidelines recommend CXR and IGRA based on local departmental policy, compared with a combination of clinical examination, CXR and IGRA in the gastroenterology and rheumatology guidelines. In total, 100% of dermatologists (28 of 28) screen patients for hepatitis B and C, compared with 92% of gastroenterologists (13 of 14) and 76% of rheumatologists (19 of 25). We found that 40% of rheumatologists (10 of 25) perform an HIV screen, in contrast to most dermatologists (92%, 26 of 28) and gastroenterologists (85%, 12 of 14; P &amp;lt; 0.05). This may be due to rheumatology guidelines recommending HIV screening only for patients with risk factors for infection. Most dermatology respondents (79%, 22 of 28) ensure a recent normal cervical smear compared with gastroenterologists (28%, 4 of 14) and rheumatologists (4%, 1 of 25; P &amp;lt; 0.05), despite all guidelines recommending patient cervical screening participation. Only dermatologists (79%, 22 of 28) performed a full skin examination (rheumatologists 0%, 0 of 25; gastroenterologists 0%, 0 of 14) to exclude cutaneous malignancy, despite an increased skin cancer risk in patients with rheumatoid arthritis and inflammatory bowel disease. Most respondents (dermatologists 79%, 22 of 28; rheumatologists 60%, 15 of 25; gastroenterologists 79%, 11 of 14) indicated that they would initially prescribe a biologic agent if an HIV, hepatitis B and C and IGRA screen was negative and performed within the preceding 6–12 months. In comparison, when managing patients established on biologic agents, most dermatologists (75%, 21 of 28), rheumatologists (84%, 21 of 25) and gastroenterologists (86%, 12 of 14) reported not following a specific timeframe to repeat this infectious disease screen, unless there was clinical concern for exposure. This survey is the first to analyse the screening and management practice variation of patients on biologic agents among dermatology, rheumatology and gastroenterology consultants. As guidelines are formulated based on evidence, these differences merit exploration to ensure safe practice and optimal healthcare resource use for this rapidly enlarging, long-term patient cohort.