Virtual multidisciplinary thiopurine monitoring: experiences from an Australian tertiary inflammatory bowel disease service

BACKGROUND: Thiopurines remain key immunomodulators for inflammatory bowel disease (IBD) but require close safety monitoring for adverse effects. AIMS: We evaluated a virtual multidisciplinary team (MDT) thiopurine monitoring service and compared it to standard care and a pharmacy-led monitoring service. METHODS: We conducted a retrospective cohort study at an Australian tertiary health service, comparing IBD patients initiated on thiopurines across three study periods: (i) prior to any thiopurine monitoring service; (ii) pharmacy-led thiopurine monitoring service; and (iii) virtual MDT thiopurine monitoring service. The MDT model involved telehealth case reviews by IBD clinicians, pharmacists and nurse consultants. Outcomes included frequency of early clinical reviews, thiopurine methyltransferase (TPMT) phenotype screening, dose optimisation, adverse effects, medication persistence and the promotion of IBD preventive care. RESULTS: A total of 285 patients were included. TPMT phenotype assessment improved across periods (80.3%, 92.5%, 95.6%; P = 0.007). Dose optimisation by 4 months was similar across cohorts (28.8%, 40.2%, 37.8%; P = 0.107). Adverse effect rates, including myelosuppression (4.9%), were comparable. Thiopurine persistence during the MDT monitoring service decreased, potentially due to increased de-escalation of combination therapy to biologic monotherapy. Promotion of cervical screening, skin checks and vaccination improved with the MDT monitoring service. Monitoring services improved the proportion of clinical reviews within 2 weeks of thiopurine initiation, although increased the total number of reviews in the first 3 months. CONCLUSION: A virtual multidisciplinary thiopurine monitoring service supported more timely clinical review, pharmacogenomic screening and systematic promotion of IBD preventive care. Adverse effect rates were similar across monitoring models. The MDT monitoring model may also facilitate recognition of patients suitable for treatment de-escalation. These findings highlight the potential of structured monitoring approaches to support safe and proactive thiopurine use in IBD, though further research is needed to assess long-term outcomes and sustainability.