Optimizing Inflammatory Bowel Disease Management: The Value of Integrated Pharmacists in Modern Health Care

Inflammatory bowel disease (IBD) encompasses a varied group of chronic inflammatory conditions of the gastrointestinal tract tissues that impact a person’s biological, psychological, and social functioning. Experts estimate that 1.6 million people in the US are living with IBDs such as Crohn disease and ulcerative colitis. Although it can impact individuals of all ages, IBD most commonly affects those between 15 and 35 years old.^1,2

Pharmacist talking with a patient | Image credit: Syda Productions | stock.adobe.com

Following the World Health Organization’s recommendation of an integrative approach regarding IBD care, a comprehensive evaluation of the pharmacist’s role in IBD management has shown to increase value through improved patient outcomes and cost savings.¹ A study in Inflammatory Bowel Diseases examined the effect of integrated pharmacists on IBD patient outcomes. These clinicians employed immunosuppressive monitoring, medication counseling, adherence measure, therapeutic drug monitoring, health promotion, and prevention, as well as sustainable drug procurement and utilization.¹

Immunosuppressive drugs and other medications that require continuous oversight are the primary drugs used in IBD care. The studyshowed that adherence to thiopurine medications after 6 months of use was 87.9% under direct pharmacist care but 65.7% under general practitioner guidance.¹ Patients were also more likely to have a proactive evaluation of blood tests and adverse effects after 3 weeks of thiopurine use (84.8% vs 8.1%) with pharmacist-led safety monitoring than traditional care.¹

A previous study showed that achieving optimal thiopurine therapy requires identifying the correct intracellular 6-thioguanine nucleotide concentration. Excessive levels cause myelosuppression, whereas insufficient levels compromise efficacy in managing IBD.³

Although pharmacists do not play a direct role in the price of pharmaceuticals, they function as the biologic coordinator, offering biosimilar medications over original medications. Biosimilars are created to closely resemble approved biologic therapies and offer drug interchangeability and economic savings for IBD patients, resulting in increased access and treatment sustainability.⁴ A UK study highlighted savings for 71 patients of $376,800 when switched to biosimilar infliximab from its originator.¹ A comparable study involving a pharmacist-led group of 112 patients transitioning to biosimilar therapy achieved annual savings of approximately $419,201 for patients.¹

Specialized pharmacists possess a distinct skill set that can significantly benefit both patients and health care systems, offering clinical and economic value in the management of IBDs. By providing comprehensive medication information, addressing patient concerns, and monitoring for adverse events, pharmacists can significantly improve treatment adherence and patient outcomes. Collaborative efforts between pharmacists, physicians, and patients are essential to ensure the successful and safe utilization of biosimilars in the management of IBD.

REFERENCES

1. Hilley P, Wong D, De Cruz P. How does an integrated pharmacist add value in the management of inflammatory bowel disease in the era of values-based healthcare? Inflamm Bowel Dis. 2024;izae196. doi:10.1093/ibd/izae196

2. Inflammatory Bowel Disease (Overview). Cleveland Clinic. Updated May 20, 2024. Accessed January 2, 2025. https://my.clevelandclinic.org/health/diseases/15587-inflammatory-bowel-disease-overview

3. Frei P, Biedermann L, Nielsen OH, Rogler G. Use of thiopurines in inflammatory bowel disease. World J Gastroenterol. 2013;19(7):1040-1048. doi:10.3748/wjg.v19.i7.1040

4. Biosimilars: What You Should Know. Crohn’s and Colitis Foundation. Accessed January 2, 2025. https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-ibd/medication/biosimilars