19/29 Frequency of blood tests for inflammatory conditions
Common inflammatory conditions including rheumatoid arthritis, inflammatory bowel disease and the spondyloarthritides, are commonly treated with immunosuppressive drugs, such as disease-modifying anti-rheumatic drugs (DMARDs).
Many of these disease-modifying drugs carry a risk of adverse events (e.g. hepatotoxicity) and thus require careful monitoring with the use of blood tests such as full blood count, liver function tests and urea and electrolyte tests. For this patient group there is uncertainty as to the optimum frequency of monitoring. Evidence suggests that for a large majority of people using these drugs, adverse events are very unlikely and the monitoring regimen itself may represent a greater burden. Testing too often is costly and places significant burden on the patient and the healthcare system, but not testing often enough could increase the risk of adverse events occurring. In recent years, this routine testing has moved into primary care. Drug manufacturers and medical guidelines provide advice on the frequency of testing (NICE guidance recommends regular blood monitoring, generally every 3 months) but these may not be strictly followed.
Therefore, the HTA programme wishes to commission research to determine the optimum strategy for the frequency of routine blood testing for patients with inflammatory conditions taking long-term immunosuppressive medication.