N26 Disease outcomes and patient’s perspectives after switching biologics from intravenous to subcutaneous administration. A real-world experience in a tertiary IBD-unit

Abstract

Abstract Background Since 2022, subcutaneous (SC) formulations of infliximab (IFX) and vedolizumab (VDZ) became available. This study aims to assess patients’ perspectives on potential switch to SC administration. Methods A prospective observational, nurse-led study was performed at the Ghent University Hospital. Patients treated with IV IFX or VDZ, deemed suitable by the treating physician based on the DIAMOND multi-stakeholder position statement of the Belgian IBD Research and Development group (BIRD), were offered switch to SC administration between 01/01/2022-30/06/2023. Participants were asked to fill out questionnaires regarding personal perspective on a potential switch to SC administration. Data was collected using REDCap®. Descriptive and univariate analyses were performed with Excel ®. The study was approved by the Ethical committee of UZ Ghent (ONZ-2022-0296). Results In total 404 patients receiving IV IFX or VDZ were identified within the inclusion period. Of those, 196 received 8-weekly treatment. After screening by the treating physician, 157 patients met the inclusion criteria of whom 84 agreed to participate (Figure 1). Questionnaires were filled out completely by 70 of the included patients. Fourty patients were treated with VDZ (57.1%) and 42.9% with IFX. Fourty-three patients (61.40%) had Crohn’s disease, 26 (37.1 %) had ulcerative colitis and 1 (1.4 %) indeterminate colitis. Fifteen patients (21.4%) had previous experience with SC self-injections. Thirty-four participants (48.6%) chose to switch to SC administration of their current treatment, 36 refused (51.4%). In general, patients were aware of the possibility to switch to SC administration before entering the study as 71% knew this formulation was available. Main information channels were: treating physician (56%) and/or IBD nurse (58%). Univariate analyses comparing switchers versus non-switchers are shown in Table 1. Patients who refused switch were more concerned about potential adverse events (agree: 61.1% vs 23.5%), loss of response (agree: 41.4% vs 11.4%) or incompliance (agree: 47.2% vs 14.7%) with SC formulations. Furthermore, the associated physician visit at the IV-administration unit was deemed more important to non-switchers (agree: 88.9% vs 55.9%). Patients who switched were less concerned about potential differences in healthcare costs (disagree: 70.6 vs 36.1%) and felt that regular visits to the IV-administration unit had big impact on QoL (agree: 64.7% vs 11.2%). Conclusion Patient’s perspectives differed significantly between those who chose to switch to SC IFX/VDZ and those who remained under the IV formulation. This should be considered when discussing treatment options with the patients and confirms the importance of patient engagement in managing IBD.