Safety of At-Home Infliximab Infusions

Maintenance doses of the biologic agent infliximab (Remicade) can be safely administered at a patient's home with a very low rate of adverse events (AEs) and serious AEs, according to research presented at the Advances in Inflammatory Bowel Diseases (AIBD) annual meeting.

In this third of four exclusive episodes, MedPage Today brought together three expert leaders in the field -- moderator Jason K. Hou, MD, of Baylor College of Medicine in Houston, is joined by Shirley Ann Cohen-Mekelburg, MD, of the University of Michigan in Ann Arbor, and Frank I. Scott, MD, of the University of Colorado, Anschutz Medical Campus in Aurora -- for a virtual roundtable discussion on the poster findings.

Following is a transcript of their remarks:

Hou: Hello, everybody. My name is Dr. Jason Hou, associate professor of medicine at Baylor College of Medicine. I'd like to welcome you all to the MedPage Today virtual roundtable. We're here discussing posters and presentations from AIBD 2022. With me today for the discussion is Dr. Frank Scott, associate professor of medicine at the University of Colorado, as well as Dr. Shirley Cohen-Mekelburg, assistant professor of medicine at the University of Michigan and Ann Arbor VA.

The next poster I'd like to discuss is an interesting description of home infusion. This was an abstract by Dr. [Yvonne] Viteri, and the group from Accredo. This poster was titled "Infliximab Infusion Related Adverse Events in the Home Setting." I think this is something that's existed for a while but especially related to COVID, this became, I think, an interesting conversation, and it's come up for patients regarding getting their infusions at home.

This was an observational cohort from Accredo, 863 patients and over 8,000 infliximab infusions from 2020 to 2021. So this was encompassing the COVID era. They identified 39 patients of the 863 who had some adverse events. And of these 860, only three of them had an event significant enough that required referral to an emergency room. So, 0.4% of patients.

I wanted to throw it to again, you, Frank and Shirley about, what are your thoughts of home infusion? This is something you offer? What is kind of your thoughts of this during this COVID era, which is when the study occurred and kind of now is emerging in the post-COVID era?

Cohen-Mekelburg: I think it's quite remarkable and definitely reassuring that 95% of patients who received these infusions didn't have any events. And then, of those that did, very few, I think single digits, presented to the emergency department. I think just to think of this in context of the wider world, there's probably some selection bias as to the patients that are in this study. It's gonna be patients that clinicians are comfortable upfront with home infusions. But I think still, the numbers of adverse effects are so low to me, it'd be interesting -- and we don't use much of home infusions here, though you can see how it improves access to care -- it'd be interesting to hear about their protocols as well as the training, let's say, of their providers who are doing the home infusions. Just so that we can think about like dissemination and reproducibility of this, it'd be interesting to know, do patients get pre-medications? Kind of what are the criteria for who would qualify for getting a home infusion? And so all that would be very interesting, and I could definitely see a future for this with infusions.

Scott: I fully agree. When I think about infliximab, in particular, I often sort of have this internalized number of 10-15% of patients will experience an infusion reaction at some point. And so this is very reassuring to see that the rates were as low as they were in this cohort. I still think from my personal practice, that there's some stratification as you mentioned, Shirley. Seeing what their protocol would be for identifying who this would be safe to pursue is going to be important. There are some biologic therapies where we've seen a lot of stratification by payers to request home infusion because of contractual relationships that they have with various infusion services that I'm very comfortable with. Vedolizumab (Entyvio) would be an example where we see a lot of that here in Colorado with regards to home infusion. And then there are others like infliximab where I'd be a little bit more reticent.

Are there particular phases in terms of induction versus maintenance therapy where you might be more comfortable thinking about home infusion for your patients?

Cohen-Mekelburg: Yeah, that's a really interesting question. In the induction phase you have no idea if, for the most part, if patients are gonna have a reaction or not until it happens. I think in maintenance you can be somewhat reassured. And again, as you mentioned, depending on the type of biologic and the reactions that we know could or couldn't happen. So yeah, that's an interesting point. I'd be curious to see were these patients mostly in maintenance versus induction.

Just from a healthcare delivery perspective, this is interesting. It improves access to care and probably adherence. On the other hand, a lot of our patients that come from far, the time they get their infusion is also an opportunity to see them, for them to get their labs drawn. And so it'd be interesting just to think about kind of some of the secondary consequences or benefits here.

Hou: Absolutely. I agree with both of you guys and the great comments both of you had. At least in my practice, I'm also not a huge user of home infusions. But I don't typically recommend for patients getting induction. Usually the patients are sick, right? We want to have a little closer contact, I feel. We have a higher level of comfort with our own nurses, not to say anything against the home-infusion nurses, but they have obviously a more direct line of contact if there's issues or concerns.

So that's at least in my practice. But I agree with you, likely some degree of bias in terms of who's getting sent out to these home referrals home infusions. But it's comforting nonetheless. And as you mentioned, Shirley, anything that can improve access for our patients is a good thing.

So as these are available, I think with COVID initially at least in our practice, we were in some ways more reluctant to send patients for home infusions because we didn't necessarily want our staff -- the travel nursing staff were maybe going from home to home, into other patients homes and things like that. But I think nowadays it's almost the opposite again, where I don't necessarily have a concern. Most of the providers, of course, are fortunately vaccinated and so on. So some of that spread into the home may be less. But again, something that we'll kind of continue to see and observe, but encouraging nonetheless.

Watch episode one of this discussion: Early-Life Antibiotic Exposure Linked to Increased Risk of Childhood IBD

Watch episode two of this discussion: Debilitating Joint Pain in Ulcerative Colitis Patients

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