Evaluation of a Pharmacist Directed Treat to Target Approach in Patients With Inflammatory Bowel Disease Receiving Upadacitinib or Risankizumab

Abstract Background An evolving strategy to enhance quality of life and remission rates in inflammatory bowel disease (IBD) is the treat-to-target approach. This approach offers a structured algorithm for therapeutic interventions, yet its implementation faces challenges, such as administrative burden and limited resources. This study elucidates the pharmacist’s role in the treat-to-target approach. Methods Retrospective chart review was conducted from August 7th to December 15th, 2023. Patients ≥ 18 years of age, diagnosed with IBD, initiated on upadacitinib or risankizumab were included. “Treat-to-target” was defined as serial communication and monitoring of symptoms, clinical response, and laboratory values at predefined time points after starting therapy. A pharmacist-led follow up protocol was conducted by an embedded IBD clinical pharmacist who assessed successful therapy initiation, medication adherence, steroid use, adverse effects, clinical disease activity, need for clinic visits, and lab monitoring at 2, 4, 8, 12 weeks, and 6, 12 months after therapy initiation. Results It was found that 227 patients initiated upadacitinib, and 210 initiated risankizumab. The overall success rate in reaching patients for through the pharmacist-directed follow-up protocol was 84%. The IBD Pharmacist made 3,512 interventions, the most common being therapy continuation and lab monitoring recommendations. Therapy discontinuations were observed, particularly between 12 weeks and 6 months post-initiation. Conclusions We demonstrate a high participation rate to a pharmacist-led follow-up and monitoring protocol for patients receiving upadacitinib and risankizumab therapy. These findings underscore the importance of pharmacist-led interventions in ensuring continuity of care and tracking patient progress with IBD therapies, which are key elements of a successful treat-to-target strategy.