Inflammatory Bowel Disease Patients’ Acceptance for Switching from Intravenous Infliximab or Vedolizumab to Subcutaneous Formulation: The Nancy Experience

Abstract

Background: Subcutaneous infliximab and vedolizumab formulations have been developed for maintenance therapy in inflammatory bowel disease. The objective of this study was to explore the inflammatory bowel disease patient’s acceptance for switching from intravenous infliximab or vedolizumab to subcutaneous, as well as to describe the causes of refusal or, conversely, the factors associated with acceptance. Methods: Patients were prospectively recruited between June 2021 and March 2022 during their infusion of infliximab or vedolizumab in the Medical Day Hospital of Nancy University Hospital. Adult patients with an established diagnosis of inflammatory bowel disease in clinical remission were eligible for inclusion in this study if they had been treated with intravenous infliximab or vedolizumab for at least six months. Results: One hundred and thirty patients were included in this study. Thirty-six patients (27.7%) received vedolizumab and ninety-four patients (72.3%) received infliximab. Median duration of treatment at inclusion was 7.0 years [3.0–11.0]. In this cohort, 77.7% of patients accepted the switch from intravenous infliximab or vedolizumab to subcutaneous. The main reasons for patient’s refusal for switching from intravenous to subcutaneous formulation were fear of loss of efficacy, a more spaced-out medical follow-up, increased frequency of administration, and self-administered injection. A short duration of treatment was associated with a high switch acceptance rate (odd ratio (OR) (95% confidence interval (CI)) = 0.9 (0.8–0.9); p = 0.0002). Conclusion: A large majority of the patients included accepted the switch of their treatment with infliximab or vedolizumab from the intravenous form to the subcutaneous form. This study identified one predictor influencing the acceptance rate in inflammatory bowel disease population: short treatment duration. Subcutaneous infliximab and vedolizumab hold potential for greater patient flexibility by self-administration, reducing travel and hospital attendance for infusion.

Switching from Intravenous to Subcutaneous Biological Therapy for Inflammatory Bowel Disease Patients Remains a Challenge

“…Other influential factors included a fear of needles, the belief that infusion is more effective, extended intervals between infusions, and a desire for consultations with a doctor after each treatment. This aligns with findings from a previous study in France, where patients resisted switching from IV to SC due to concerns about a potential loss of efficacy, a more spaced-out medical follow-up, increased administration frequency, and the introduction of self-administered injections [15].…”

“…Notably, only a quarter of patients were aware of the subcutaneous administration option for therapeutic agents [ 14 ]. In a study conducted at Nancy Hospital in France, 16.7% of vedolizumab patients and 24.5% of those treated with infliximab declined to transition from IV to SC [ 15 ].…”

Real-World Study on Vedolizumab Serum Concentration, Efficacy, and Safety after the Transition from Intravenous to Subcutaneous Vedolizumab in Inflammatory Bowel Disease Patients: Single-Center Experience

“…Some patients, moreover, dislike the idea of self-injecting or more frequent dosing of subcutaneous formulations [ 15 ]. In recent studies on patient acceptance of switching from intravenous infliximab or vedolizumab to subcutaneous formulations of the drug, the majority (58–78%) of the patients accepted the switch, and the main motivation was saving time [ 16 , 17 ].…”

Vedolizumab subcutaneous formulation maintenance therapy for patients with IBD: a systematic review and meta-analysis

“…51 A relatively large number of trials on VDZ SC reported satisfactory outcomes. 34,[36][37][38][39][40][41][52][53][54][55][56][57][58][59][60] Therefore, we sought to systematically review studies on VDZ SC for treating patients with IBD and to meta-analyze studies with relatively complete outcomes.…”