{
  "abstract": "Introduction Advanced therapies (AT) have revolutionized the management of Inflammatory Bowel Disease (IBD), but pathways for accessing AT vary between UK regions/countries, with potential inequity in patient care.Methods A national cross-sectional web-based survey was sent to UK hospital IBD services, capturing service structure and access to AT. This analysis reports preliminary findings.Results 76 IBD services responded. 55 services (73%) have specialist IBD pharmacy support with 19 (25%) running pharmacist-led clinics. 10/71 services (14.1%) reported unrestricted access to AT; all others had approval processes or reported lack of access to at least one therapy.Among respondents from England and Wales (71/76), Azathioprine monotherapy is used first line in ulcerative colitis (33,46.5%) and Crohn’s disease (22,31.0%). Across the UK anti-TNF is accepted as first line AT for UC and CD, especially with the licensing of biosimilars. Access to other AT varied substantially, as shown in table 1.In UC, after anti-TNF, vedolizumab was the most accessible first line, with access for 64/71 services (90.1%), including 31 (43.7%) requiring no approvals. Ustekinumab first-line was more limited, reported by 50 (70.4%) services. Similar patterns were observed for ustekinumab biosimilars, p19 inhibitors and JAK inhibitors, which were accessible in 51-52 services (71.8-73.2%). 6 services (8.5%) reported first-line access to ustekinumab biosimilars, but no access to originator. S1P modulators were more restricted with 32 (45%) services having access for first line therapy in UC. Although access improved at second line across most drug classes, S1P modulators remained more restricted with only 50.7% of services reporting access.In CD, vedolizumab was accessible in 64/71 services (90.1%), including 31 (43.7%) with unrestricted access, while ustekinumab was available in 55 services (77.5%). P19 inhibitors and JAK inhibitors were accessible as first line in 51 services (71.8%).32/76 (42%) services participate in clinical trials; Phase 1: 9.2%, Phase 2: 15.8%, Phase 3 trials (32.9%) and Phase 4 (25.0%).Cost (45/76, 59%) and restrictions (26/7, 34%) imposed by local approval committees were the most frequently reported barriers to AT choice. 68/76 services (89%) believed access to IBD AT is inequitable across the UK.Conclusion IBD-TAPAS reveals marked national variation in access to IBD AT, driven predominantly by local governance, cost pressures and infrastructure rather than clinical guidance or published data. This highlights an urgent need for nationally aligned commissioning and streamlined governance to ensure equitable access to IBD AT.Abstract P236 Table 1Percentage of IBD service able to access each AT (n=71)Drug classFirst Line n(%)Second line n(%)UCCDUCCDUstekinumab 51 (71)54 (77)55 (77)55 (78)Vedolizumab64 (90)63 (90)65 (92)60 (85)JAK inhibitors52 (73)51 (72)54 (76)53 (76)P19 inhibitors51 (72)51 (72)53 (75)53 (76)S1P modulators31 (45)33 (47)36 (51)33 (48)",
  "authors": [
    {
      "affiliations": [
        "Kings College Hospital NHS Foundation Trust, London, England"
      ],
      "name": "Rubin George"
    },
    {
      "affiliations": [
        "University Hospitals of Sussex NHS Foundation Trust, Brighton, England"
      ],
      "name": "Fiona Rees"
    },
    {
      "affiliations": [
        "University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, England"
      ],
      "name": "Wendi Harrison"
    },
    {
      "affiliations": [
        "Kings College Hospital NHS Foundation Trust, London, England"
      ],
      "name": "Polychronis Pavlidis"
    },
    {
      "affiliations": [
        "University Hospital of Wales, Cardiff, Wales"
      ],
      "name": "Clare Tibbatts"
    },
    {
      "affiliations": [
        "Southern Health & Social Care Trust, Craigavon, Northern Ireland"
      ],
      "name": "Andrew Murdoch"
    },
    {
      "affiliations": [
        "Forth Valley Royal Hospital, Larbert, Scotland"
      ],
      "name": "Santosh Salunke"
    },
    {
      "affiliations": [
        "Western General Hospital, Edinburgh, Scotland"
      ],
      "name": "Shahida Din"
    },
    {
      "affiliations": [
        "Kings College Hospital NHS Foundation Trust, London, England"
      ],
      "name": "Alexandra Kent"
    }
  ],
  "title": "P236 IBD-TAPAS: a UK survey to assess IBD therapy access pathways and selection",
  "uid": "1087f761-b898-52dc-9774-c9584987f2d6"
}