P0654 Switching from intravenous to subcutaneous infliximab: physicians’ practice and patients’ satisfaction - Results from a nationwide transectional study
Authors: Hupé M , Laharie D , Wils P , Uzzan M , Peyrin-Biroulet L , Kirchgesner J , Atanasiu C , Cadiot G , Richard N , Simon M , Caillo L , Nancey S , de Maissin A , Vuitton L , Hébuterne X , Alric H , Coffin B , Gellouz S , Buisson A ,   GETAID
Published: January 2025

Abstract

Background
Subcutaneous (SC) infliximab is efficient and safe in inflammatory bowel diseases (IBD), but no guidelines exist regarding practical modalities of switching from IV to SC infliximab.
This study aimed to describe current practice in France, assess patients’ experience, and identify factors associated with higher satisfaction levels.

Methods
Two questionnaires were created for this nationwide cross-sectional study. Each practitioner completed a physician questionnaire and provided a patient questionnaire to all consecutive patients receiving infliximab (IV or SC) over an 8-weeks period. Factors associated with a higher satisfaction following switch, assessed using a 10 points numerical scale (10=completely satisfied) were explored using a multivariate analysis.

Results
Among 48 responding physicians, the switch was proposed more readily for patients in deep remission (97.9%), after infusion-related reactions (91.7%), or for cost-saving reasons (52%). Perianal lesions did not discourage the switch (83.3%), contrary to concerns about reduced infusion unit activity (68.9%) and poor adherence (52.1%). The first SC injection was mainly performed instead of the next IV infusion (77.3%). Immunosuppressive therapy was maintained (87.5%) for patients treated with combination therapy, generally for 6 months.
Among 241 enrolled patients, 33.6% had switched to SC infliximab including 14 (17.3%) receiving an intensified SC dose immediately after the switch. Most of these patients (13/14) were on IV infliximab ≥ 10mg/kg/8-weekly prior to switch, had Crohn’s disease (13/14), had received IV infliximab for more than 5 years (10/14) and did not receive concomitant immunosuppressive therapy at the time of switch (10/14). Patients who did not switch cited absence of information regarding the SC option (22.0%), concern over altered medical follow-up (15.2%), and fear of disease relapse (11.4%) as most frequent reasons. Among those who switched, the median satisfaction score was 10/10 [8.0-10.0], even in patients immediately switched to optimized SC infliximab (10/10 [9.0-10.0]). The switch was felt as improving disease activity in 43/77 (55.8%) of patients. 60.5% reported no apprehension before SC injection, whereas 16.0% rated their apprehension above 4/10. No serious adverse events were reported; local injection site reactions (erythema or oedema) were reported only in 7.4% of cases. Multivariate analysis showed that patients’ satisfaction was correlated with the duration of prior IV infliximab treatment (p=0.040).

Conclusion
This nationwide study provides an overview of current physicians’ practices for switching from IV to SC infliximab that could help for editing guidelines and demonstrates high level of patients’ satisfaction after switch.