Chong Teik Lim, MD1, Wan Chee Ong2, Hang Hock Shim, MBBS2, Elaine Chan2, Teong Guan Lim2, Kia Lan Loy2, Webber Chan2
1Changi General Hospital, Singapore, Singapore; 2Singapore General Hospital, Singapore, Singapore
Introduction: The recommended infusion time for infliximab for inflammatory bowel disease (IBD) is 2 hours or more. Time spent on receiving infliximab infusions in the hospital disrupts school and work activities. Significant nursing time is also spent which increases healthcare costs. Shortening infliximab infusion to over 1 hour has been shown to be safe and has the potential to decrease time spent in hospital. This study aims to determine the safety and effectiveness of this accelerated infliximab infusion protocol in patients with IBD in Southeast Asia.
Methods: We conducted a retrospective study on patients with Crohn’s disease (CD) and ulcerative colitis (UC), who received infliximab from September 2018 to May 2019 at Singapore General Hospital. Patients on stable maintenance infliximab were offered the accelerated protocol if they had tolerated ≥4 infliximab infusions without reactions. The need for pre-medications was determined by the prescribing physician. Primary endpoint was infusion-related reaction rate and secondary endpoints were cost and time saved per infusion.
Results: A total of 187 infusions were administered to 57 patients (53 CD, 4 UC). The mean age was 52.0 ± 17.0 years and 61.4% of the subjects were male. Out of the 57 patients, 22 of them received the accelerated infusion protocol with a total of 86 1-h infusions. Three reactions (1 immediate, 2 delayed) were observed during the 1-h infusions and were reverted back to the standard 2-h infusion subsequently. However, this was not found to be statistically significant after adjustment for age, sex, administration of pre-medications or types of disease.
The median time spent per infusion in the hospital for the accelerated infusion protocol was significantly reduced compared to for the standard infusion (138 ± 26 minutes vs. 216 ± 26 minutes; p < 0.05) This improvement amounts to an estimate of 65 minutes returned to the patient for normal activities outside of the hospital per infusion. There was also a reduction in nursing time and cost (S$ 42.9 per infusion and 46.4% relative cost reduction) to the hospital.
Discussion: The accelerated infliximab infusion protocol is safe in our cohort of IBD patients. It also results in a decrease in in-hospital time for patients and improves the efficiency of healthcare delivery.
Citation: Chong Teik Lim, MD; Wan Chee Ong; Hang Hock Shim, MBBS; Elaine Chan; Teong Guan Lim; Kia Lan Loy; Webber Chan. P1421 - ACCELERATED INFLIXIMAB INFUSION PROTOCOL FOR INFLAMMATORY BOWEL DISEASE: A SAFETY AND COST-EFFECTIVENESS STUDY IN AN ASIAN TERTIARY CENTER. Program No. P1421. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.