1. UK IBD audit Biological therapies audit 2014 Comparison of (Your site name) results against the national results for the clinical audit of biological therapies (Name of presenter)

2. Participation • Sites are eligible to participate if they give biological therapy to IBD patients. • 23 out of the 25 (92%) specialist paediatric IBD sites are participating in the biological therapies audit or in the Personalised Anti‐TNF Therapy in Crohn’s disease study (PANTS) • On 28 February 2014, details of 524 patients had been entered. • Only those cases that are locked on the data collection web tool are able to be included in national analyses

3. Key resultsSummary of paediatric patients included in national analysis a 30 patients with CD / 4 with UC / 4 with IBDU were treated with both IFX and ADA

4. Key resultsSummary highlighting key data items for CD a Denominators change to exclude cases where date / disease severity score was not provided b Where a patient switched treatment, the first treatment the patient received was used

5. Key resultsSummary highlighting key data items for CD continued

6. Key resultsSummary highlighting key data items for CD continued a Denominators change to exclude cases where date / disease severity score was not provided

7. Key resultsAudit objective: appropriateness of prescribing anti-TNFαCD paediatric compliance with a selected TA187 NICE criterion

8. Key findings • Participation by specialist paediatric sites was encouraging 92%. • It is likely that a minority of cases were entered at some sites. • 524 paediatric patients audited of these there were: • 488 initial treatments with infliximab and, • 74 initial treatments with adalimumab • For patients with CD, treatment with a biologic resulted in • response rate of 77% • remission in 65% of patients • Informed consent to receive treatment is taken for the majority of patients (99%) • Recorded adverse events for patients with IBD are uncommon. • Acute treatment reactions and infections are the commonest events, recorded among 10% and 7% of all patients, respectively.

9. Key findings continued • 80% of patients with Crohn’s disease are receiving concomitant immunosuppression at initial treatment. • The use of biologics in paediatric patients with ulcerative colitis is increasing. • Routine collection of patient-reported outcome measures (IMPACT III) is low in clinical practice • 18% at baseline • 5% at either 3- or 12-month follow-up. • 12% of patients with CD were appropriately prescribed in compliance with NICE criterion 1.5 (TA187)

10. Key findings continued • Severity of CD at initial treatment, assessed PGA, was reported as moderate in 54% of patients, severe in 37% and mild in 8%. The majority of patients being started on anti-TNFα treatment for CD had a median PCDAI score of 23, indicating a disparity between the two assessments. • Children with Crohn’s disease receive treatment with a biologic significantly earlier in the disease course than adults 1.42 vs 5.23 years, respectively.

11. National recommendations / action plan

12. National recommendations / action plan cont.

13. National recommendations / action plan cont.

14. Thank you for your continued effort in supporting the work of the UK IBD audit • Your feedback and views are very important to us, please give us your thoughts: • Tel: 020 3075 1566 • Email: biologics.audit@rcplondon.ac.uk