Document resource
Switching from intravenous infliximab (IV-IFX) to subcutaneous infliximab (SC-IFX) has been shown to increase infliximab trough levels, reduce immunogenicity and be broadly cost-neutral in adult inflammatory bowel disease (IBD). 1 2 However, evidence in adolescent IBD remains limited. This on-going quality improvement project (QIP) aims to evaluate the economic, environmental and clinical outcomes of switching adolescents with IBD from IV-IFX to SC-IFX.In this prospective, single-centre QIP, adolescents (aged 16-17) with IBD receiving IV-IFX maintenance therapy for ≥ 3 months were offered switching to 120mg SC-IFX every-other-week.3 A Trust-specific economic model compared direct and indirect costs of IV-IFX and SC-IFX, covering NHS, Trust and family costs. Environmental impact was estimated based on travel-related greenhouse gas emissions (GHGs). Patients who agreed to switch were scheduled for clinical assessments at baseline and weeks 4, 8, 16, 24 and 52 post-switch. Patient satisfaction surveys were scheduled for 16 and 52 weeks post-switch.Economic modelling based on 26 eligible switching patients estimated a total annual per-patient saving of £3318.92 with SC-IFX. The annual direct saving per-patient was £2262.80, representing an approximate 35% cost reduction to the healthcare system. Median per-patient annual travel-related GHGs from IV-IFX was an estimated 27.5 kgCO2e, expected to be negligible with home-administered SC-IFX.Between February and May 2025, five male adolescents (median age 17.3 years), all with Crohn’s disease, were switched. All three patients in disease remission at baseline maintained remission at week 4. One patient with refractory disease did not regain response by week 8, while the remainder continued SC-IFX with no adverse events. Median infliximab trough levels increased by 3.4 mg/mL at week 4.SC-IFX substantially reduces healthcare and patient costs, as well as travel-related GHGs, in adolescent IBD within our Trust. Preliminary findings suggest that SC-IFX is well-tolerated in adolescents with early signs of clinical benefit. Full 52-week data and larger studies are required to confirm long-term safety, efficacy and sustainability.References Papamichael K, Lin S, Moore M, Papaioannou G, Sattler L, Cheifetz AS. Infliximab in inflammatory bowel disease. Therapeutic Advances in Chronic Disease. 2019. doi:10.1177/2040622319838443.Schreiber S, Ben-Horin S, Leszczyszyn J, Dudkowiak R, Lahat A, Gawdis-Wojnarska B, et al. Randomized controlled trial: subcutaneous vs intravenous infliximab CT-P13 maintenance in inflammatory bowel disease. Gastroenterology 2021. doi:10.1053/j.gastro.2021.02.068.National Institute for Health and Care Excellence. Remsima (infliximab biosimilar) for subcutaneous injection for managing Crohn’s disease and ulcerative colitis. https://www.nice.org.uk/advice/es35/chapter/Product-overviewAbstract OC84 Figure 1Annual per-patient cost differences when switching from intravenous to subcutaenous infliximab