Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2020; 26(36): 5437-5449
Published online Sep 28, 2020. doi: 10.3748/wjg.v26.i36.5437
Transitioning patients with inflammatory bowel disease from hospital-based to rapid home-based infliximab: A stepwise, safety and patient-orientated process towards sustainability
Anuj Bohra, Qurat-Al-Ain Rizvi, Charlotte Yuen Yu Keung, Abhinav Vasudevan, Daniel R van Langenberg
Anuj Bohra, Qurat-Al-Ain Rizvi, Charlotte Yuen Yu Keung, Abhinav Vasudevan, Daniel R van Langenberg, Department of Gastroenterology, Eastern Health, Box Hill 3128, Victoria, Australia
Anuj Bohra, Abhinav Vasudevan, Daniel R van Langenberg, Eastern Health Clinical School, Monash University, Box Hill 3128, Victoria, Australia
Author contributions: Bohra A performed the acquisition of data, analysis and interpretation of data, statistical analysis and drafting of manuscript; Rizvi QAA designed the patient questionnaires and performed acquisition of data; Keung CYY performed the acquisition of data; Vasudevan A provided critical revision of the manuscript; van Langenberg DR designed the study concept, performed analysis of data and critical revision of the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Human Research Ethics Committee at Eastern Health as audit activity and the committee provided a waiver for informed consent. Reference number: LR 64/2017.
Informed consent statement: The study was reviewed and approved by the Human Research Ethics Committee at Eastern Health as audit activity and the committee provided a waiver for informed consent. Reference number: LR 64/2017.
Conflict-of-interest statement: None declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Anuj Bohra, BMed, Doctor, Research Fellow, Department of Gastroenterology, Eastern Health, 3 West, 8 Arnold Street, Box Hill 3128, Victoria, Australia. anujbohra@hotmail.com
Received: May 28, 2020
Peer-review started: May 28, 2020
First decision: July 25, 2020
Revised: August 10, 2020
Accepted: September 5, 2020
Article in press: September 5, 2020
Published online: September 28, 2020
ARTICLE HIGHLIGHTS
Research background

Infliximab is one of the most commonly used biologic therapies in the management of inflammatory bowel disease (IBD). With the development of infliximab biosimilars and resulting reduction in medication cost, its availability and usage worldwide has seen exponential growth for all therapeutic indications.

Research motivation

Previous studies have suggested rapid 30 min infliximab infusions to be safe in patients with IBD. Despite this, few centres have moved to deliver infliximab therapy for IBD at a patient’s home and there remains a paucity of literature demonstrating the cost benefit of rapid infliximab infusion compared to standard therapy.

Research objectives

The primary aims in this study were to evaluate the safety of transition from standard hospital-based infliximab infusions to rapid infusions and thence to home-based infusions in a protocolised manner, while also assessing efficiency, cost savings and patient satisfaction with this process.

Research methods

This retrospective study was conducted across two tertiary IBD centres in Australia. Based on pharmacy prescribing records and historic IBD databases, patients who received infliximab over a 12-year period were identified. Data related to infliximab therapy was retrospectively obtained. Patients that were transitioned to at home infliximab were prospectively surveyed for satisfaction and productivity.

Research results

Our study reinforced previous findings in showing that rapid 30 min infliximab was safe in patients IBD with minimal side effects. Furthermore, with careful patient selection patients receiving rapid infusion infliximab were able to be safely transitioned to home based therapy. Rapid infliximab infusions resulted in the halving of time patients spent receiving an infusion and resulted in a 54% reduction in delivery related costs. Patients found the transition to rapid infliximab to be highly satisfying but were neutral about receiving infliximab therapy at home.

Research conclusions

In our study, rapid 30 min infliximab infusions appeared to be safe and in a protocolised manner could be delivered safely at home. This process has the ability to substantially reduce costs related to delivery of therapy and provides a viable alternative to under resourced infusion centres in the delivery of infusion therapy.

Research perspectives

Rapid Infliximab therapy can be delivered safely at home under the supervision of trained health care staff. Our study provides a framework for other centres to selectively transition patients from traditional infusion centres to alternative destinations such as home based. With further safety studies other infusion therapies could potentially be transitioned safety to be delivered at home at the convenience of the patient.