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Initiation of subcutaneous infliximab (Remsima) therapy for the treatment of inflammatory bowel disease during the COVID-19 pandemic
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  1. John McGoran1,
  2. Alan Wilson2,
  3. Shannan McErlain2,
  4. Noreen Kennedy1,
  5. Caroline Masterson1,
  6. Caroline Collins1,
  7. Graham Morrison1
  1. 1Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK
  2. 2Pharmacy, Belfast Health and Social Care Trust, Belfast, UK
  1. Correspondence to Dr Graham Morrison, Gastroenterology, Belfast Health and Social Care Trust, Belfast BT13 1FD, UK; graham.morrison{at}belfasttrust.hscni.net

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Promising evidence in the subcutaneous (SC) administration of the infliximab (IFX) biosimilar CT-P13 (Remsima) has emerged in recent years. Furthermore, immunogenicity data have suggested superior steady state therapeutic blood levels of IFX and lower rate of anti-IFX antibodies in a cohort of patients receiving SC Remsima following two intravenous induction doses in contrast to their counterparts who continued to receive intravenous therapy.1 2 In response to the challenges posed by the COVID-19 pandemic to patients with inflammatory bowel disease (IBD) receiving IFX, we embarked on a patient-partnered programme in switching to SC Remsima. Seventy-five individuals were included in the preliminary service development and some demographics are outlined in table 1. An assessment of patients’ attitudes was conducted using a survey.

Table 1

Demographic details of patients undergoing intravenous to subcutaneous infliximab switch

Once patients agreed to change to SC Remsima, they were sent information via email, with contact information and a link to an instructional video which can be found here https://www.youtube.com/watch?v=KUaxysZxbU0. From 30 March 2020 to 15 May 2020, 75 patients had received SC Remsima.

Forty-one patients returned surveys before the end of July 2020, representing a 54.7% return. Twenty-five (61.0%) participants clearly indicated feelings of apprehension and anxiety prior to starting SC Remsima, with a majority of respondents countering this by expressing positive outlooks on changing therapy to a SC form. The emergence of the COVID-19 pandemic and measures taken to alter healthcare provision had a major impact on patients’ impressions of their treatment. The convenience of avoiding hospital appointments for intravenous infusion therapy and the enhanced control afforded by this therapy were commonly perceived benefits.

The majority of adverse events related to injection site problems like pain and swelling, with at least 12 (29.3%) experiencing such issues. This was the most commonly cited reason for opting to return to intravenous IFX. Besides concerns about injection site issues, suggestions for improvement focused on better interaction between healthcare provider and patient. Clear benefits of attending hospital were espoused by some respondents, from potentially obvious to the team: ‘I found the observations done before the IV very useful’; to more unique insights: ‘As someone who lives alone there was a ‘social’ element of hospital attendance’.

Healthcare provider experiences and patient feedback have demonstrated a successful transition from intravenous to SC IFX for the majority. The early identification of pitfalls is essential in achieving a sustainable service of good quality. A patient-centred approach will mean catering also to those who may find it difficult to adapt. As one of the first centres to establish SC Remsima for our IBD patient group, this has been an insightful experience that will guide better approaches to holistic care in the future.

References

Footnotes

  • Contributors JMG is lead author and designed the patient survey. AW led the initial service improvement and contributed to the article. SME supported the service development and contributed to the article. NK supported the service development and contributed to the article. CM supported the service development and contributed to the article. CC supported the service development and contributed to the article. GM was clinical lead for service development and is senior author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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