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BACKGROUND: Recent trials support the clinical efficacy and safety of subcutaneous infliximab (IFX) or vedolizumab (VDZ) for Inflammatory Bowel Disease (IBD). We evaluated the uptake and rationale for choosing to switch from intravenous infusions to subcutaneous injections. METHODS: Retrospective analysis of all adult patients receiving standard dosing IFX or VDZ maintenance therapy to investigate uptake of subcutaneous injections and the rationale for switching to subcutaneous injections. RESULTS: Of 232 eligible patients (total = 258: IFX = 190, VDZ = 68, and no longer eligible = 26), 58% of patients on IFX and 59% of patients on VDZ chose to switch to subcutaneous treatment. Age, sex, diagnosis, drug, line of treatment, and duration of treatment were not predictors for willingness to switch. Questionnaire responses (n = 51) demonstrate that the decision to switch was not influenced by COVID-19 exposure risk, impact on wider IBD service provision, impact on patient mental health, financial savings, seeking support following a switch, or a sense of independence managing IBD. Switchers (68%) were more motivated by time savings than non-switchers (25%; p = 0.0042). CONCLUSIONS: Switch uptake rates were 58%, with 90% of patients eligible to switch. Switch decision was influenced by time savings for patients but not by other patient-related factors.
RESUMEN
BackgroundRecent trials support the clinical efficacy and safety of subcutaneous biologic treatment for IBD maintenance therapy. Administration of subcutaneous injections could reduce the financial burden and time required to attend for infusions and allow IBD service providers to manage increasing clinical demand. We evaluated the uptake and rationale for choosing to switch from intravenous infusions to subcutaneous injections, including the impact of the Covid-19 pandemic on IBD service provision.MethodsWe performed a retrospective analysis including all adult patients receiving standard dosing maintenance Infliximab (IFX) or Vedolizumab (VDZ) therapy at a tertiary IBD centre. We investigated the uptake of the switch from intravenous infusions to subcutaneous injections and utilised a standardised patient questionnaire to determine the rationale for switching to subcutaneous injections or not, and to identify areas for improvement in IBD service provision for the switching process.ResultsOf 232 eligible patients (total 258, IFX = 190, VDZ = 68, no longer eligible = 26), 58% of patients on IFX and 59% of patients on VDZ chose to switch to SC treatment. There were no significant predictors for willingness to switch relating to patient age, sex, diagnosis, drug, line of treatment or duration of treatment (p>0.05).Patient questionnaire responses (n=52) demonstrate that a decision to switch was not influenced by Covid-19 exposure risk, the impact on wider IBD service provision, impact on patient mental health, financial savings, seeking support following a switch or a sense of independence managing IBD. Switchers (69%) were more motivated by time savings than non-switchers (24%). Most patients value face-to-face support at the IBD unit (90% switchers, 96% non-switchers) and utilise this time to seek support for managing IBD (75% switchers, 95% non-switchers).Most patients felt they received enough time (84% switchers, 76% non-switchers) and information (84% switchers, 77% non-switchers) to make a decision about switching. 61% of switchers reported concerns about the efficacy of SC injections compared to only 28% of non-switchers. Most patients report being happy with their decision (80% switchers, 76% non-switchers). 31%of non-switchers are now considering a switch.ConclusionsSwitch uptake rates were 58% with 90% of patients eligible to switch. We found no evidence that a decision to switch was influenced by age, sex, diagnosis, drug, line of treatment or duration of treatment. Non-switchers value face-to-face support at the IBD unit highly, and switchers value the time saved by administering injections at home. Most patients felt they were given sufficient time and information to decide on switching and did not have concerns regarding the safety or efficacy of subcutaneous injections.