Canadian journal of gastroenterology & hepatology
Optimising Blood Test Monitoring Frequency for Inflammatory Bowel Disease Patients: Balancing Adherence, Comfort and Risk
By Ravikulan A and Irwin J.
Abstract
Background
Inflammatory bowel disease (IBD) therapies can cause myelosuppression and hepatitis. The European Crohn's and Colitis Organisation (ECCO) recommends 3-monthly blood test monitoring; however, these recommendations are largely based on expert consensus, and real-world evidence informing optimal long-term monitoring intervals remains limited.
Aim
To determine the incidence of medication-related hepatitis and myelosuppression in a population-based IBD cohort and estimate the laboratory monitoring burden required to detect clinically significant adverse events.
Methods
A retrospective cohort study was performed using the Manawatū IBD incidence cohort. Patients diagnosed with IBD between 1 January 2011 and 31 December 2015 were followed longitudinally until 31 December 2022. Medication exposure, laboratory results, and clinical outcomes were recorded. Hepatitis was defined as alanine aminotransferase (ALT) > 2 × the upper limit of normal, while myelosuppression was defined as a neutrophil count < 1.0 × 109/L. Patients were followed from diagnosis until the first outcome event or last recorded follow-up. Medication exposure was analysed as a time-varying variable using cox proportional hazards regression, and the duration of laboratory monitoring required to detect one adverse event was calculated.