P102 Does a joint Doctor-Pharmacist clinic improve outcomes for autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) patients? a retrospective single-centre pilot

<h3>Introduction</h3> AIH and PBC are rare immune-mediated inflammatory liver diseases. AIH is managed using long-term immunomodulation and PBC with medications affecting bile acid synthesis; both strategies can have variable outcomes and/or adverse drug reactions (ADR) and, if not managed appropriately, both can lead to end-stage liver disease. We identified a refractory cohort of patients we were struggling to manage and questioned whether a joint clinic between a gastroenterologist and prescribing pharmacist might not enable better and more timely management decisions, especially around drug changes, thereby improving outcome. Additional support for frequent blood test monitoring would be a key factor in success. <h3>Methods</h3> A monthly joint gastroenterologist and specialised prescribing pharmacist clinic was created. Clinic lists were used to ensure whole cohort review. A standardised data tool was used. All joint clinics from start of project were reviewed; April 2023 to May 2024, amounting to 88 appointments. <h3>Results</h3> A total of 88 appointments were reviewed. 33 patients were seen; 21 AIH, 3 overlap AIH/PBC, 1 AIH/PSC, 2 PBC and 6 patients incorrectly booked (4 with alcohol-related liver disease, 1 MASLD and 1 reflux). Only the AIH +/- overlap (n=27) were included in analysis. Review outcomes: On average patients were seen in clinic 2.7 times (range 1–7) with majority (n=22) requiring supplemental pharmacist intervention; on average 7.5 additional interactions (range 0–24) during the review period. Reasons for additional contact included steroid reductions (50), clinic administration (32), prescription organisation (29), blood test review - not requiring change (25), medication advice (14), ADR queries (13), infection-related queries (10), steroid increases (9), new medication starts (6). Medication changes: 19 patients on prednisolone, 8 on combination prednisolone-budesonide, 1 on budesonide only. All steroid-dependant patients started on steroid-reduction management plan since start of joint clinic. 22 prescribed azathioprine, 12 stopped due to intolerance. 8 of these patients were switched to mercaptopurine, with only 2 stopping due to intolerance. 8 prescribed mycophenolate, 5 stopping due to intolerance. 7 prescribed tacrolimus, 4 stopping due to intolerance. 2 ursodeoxycholic acid optimisation. <h3>Discussions</h3> Refractory autoimmune liver patients require high-volume and expert drug knowledge input to ensure favourable outcomes. The joint clinic has now enabled all patients to be on appropriate and tolerated management plan, and prescribing pharmacists can autonomously and appropriately action this, improving physician capacity and patient experience plus upskilling the pharmacy workforce. Administration support is important to ensure best use of clinician capacity. <h3>References</h3> AASLD practice guidelines: management of autoimmune hepatitis. Nov 2019. https://www.aasld.org/practice-guidelines/management-autoimmune-hepatitis EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. 6474JHEPAT 145..172 (easl.eu).<i> Journal of Hepatology.</i> 2017;<b>67</b>:145–172.