Accelerated Infliximab Infusions a Positive for IBD Patients

Patient satisfaction rose drastically with accelerated infliximab infusions as a treatment for inflammatory bowel disease (IBD).

A team, led by Harry Crane, MBBS, Gastroenterology Advanced Trainee, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute of Applied Medical Research, assessed the safety of accelerated infusions for standard and dose-intensified infliximab regimens and the effect on patient satisfaction and potential cost savings.

Current Practice for Infliximab

Infliximab is a monoclonal antibody with a high affinity for tumor necrosis factor-alpha and is 1 of the most commonly prescribed treatments for both ulcerative colitis and Crohn’s disease. However, a long infusion duration and monitoring process is often burdensome to both patients and health care providers.

There is also a reported reaction incidence rate of 2-3% of infusions, occurring both within 1-2 hours of completion or 1-2 weeks following treatment.

“The precise underlying mechanisms of infusion reactions are incompletely understood and probably diverse,” the authors wrote.

Infliximab is currently recommended to be administered over 2 hours, followed by 1-2 hours of monitoring.

Theoretically, accelerated infusions with shorter observation times could increase the risk of infusion reactions, but if not would increase patient satisfaction.

In addition, the majority of previous studies have focused more on standard dose infliximab, with very few looking at the safety of accelerated infusions for dose-intensified infliximab.

The Study

In the single center, prospective study, the investigators examined 52 patients with IBD receiving a stable maintenance dose of infliximab in clinical remission. These patients received at least 1 accelerated infusions, over 30 minutes if receiving standard-dose 5 mg/kg treatment or over 60 minutes if receiving dose-intensified infliximab of up to 10 mg/kg. Overall, the 52 patients received 150 total infusions.

The investigators sought main outcomes of incidence of acute or delayed reactions, patient satisfaction, and potential cost savings. The team also explored infliximab trough levels following 1 and 3 accelerated infusions.

Safety and Patient Satisfaction

The incidence of reactions to accelerated infusions was 3.3% (n = 3) in the standard-dose group, compared to 0% (of 61 infusions) in the dose-intensified infliximab arm. All of the reactions identified in the study were delayed, mild, and self-limiting and did not require drug cessation.

In addition, patient satisfaction was improved as the infusion time shorted, compared to patients’ previous experiences (P = 0.00002).

The investigators also found mean plasma trough level of infliximab reduced from 9.3 mg/L (± 4.9) to 7.9 mg/L (± 4.1) (P = 0.02) with accelerated infusions, while no patient developed anti-infliximab antibodies.

Cost Savings

The cost savings were also profound.

There was an estimated $123.52 and $247.04 per-patient per-year in nursing cost savings for standard and dose-intensified infliximab, respectively.

“Accelerated infliximab infusions for standard and dose-intensified regimens seems to be safe and improved patient satisfaction,” the authors wrote. “

While the initial results are positive, the investigators said the potential impact on drug trough levels requires further research.

The study, “Safety, satisfaction, and cost savings of accelerated infusions of standard and intensified-dose infliximab for inflammatory bowel disease,” was published online in the Internal Medicine Journal.