Home and hospital-based infliximab infusion outcomes
Abstract:
Background: Pediatric inflammatory bowel disease (IBD) is commonly treated with infliximab in a hospital setting. Utilization of home infusions (HI) is increasing due to insurance mandates, travel time savings, and convenience. We evaluated adverse outcomes (AOs) of infliximab infusions in children with IBD receiving HI compared to hospital-based infusions.
Methods: Children receiving HI between September 2016-September 2018 were retrospectively matched based on age, race, ethnicity, sex, and disease type to a cohort receiving infliximab at a hospital-based center. A survival analysis evaluated the hazard ratio for AOs in HI relative to hospital-infused children over 2 years. AOs were defined as discontinuation of therapy for clinically relevant reasons, IBD-related hospitalizations, and emergency department visits.
Results: We included 102 children (51 pairs) (63% male, 91% White, 92% Crohn’s disease). Disease location, behavior, growth status, and disease severity were similar between the two cohorts. Quiescent disease increased from 3% to 93% after 2 years without cohort differences. At baseline, 94% of HI patients and 88% of controls were on 5 mg/kg every 8 weeks as standard maintenance therapy. Within 2 years, only 19% remained on 5 mg/kg and the remainder required increased dosing or decreased interval. The HI cohort had fewer labs obtained (p<0.001), though laboratory values, number of clinic visits, and frequency of AOs were similar.
Conclusion: Drug durability, AOs, and laboratory values were similar between HI and hospital-based infusions. These findings suggest HI may be as effective as hospital-based infusions, provided a standardized care approach is utilized.
Reference:
Gupta SR, Bricker J, Boyle BM, Maltz RM, Michel HK, Dotson JL. Outcomes for standardized home and hospital-based infusions of infliximab for children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2023 Mar 17. doi: 10.1097/MPG.0000000000003772. Epub ahead of print. PMID: 36930973.