Home infliximab infusions suboptimal for inflammatory bowel disease

Last Updated: 2020-08-27

By Lisa Rapaport

(Reuters Health) - Patients with inflammatory bowel disease who use home infliximab infusions are more likely to be nonadherent and discontinue treatment than their counterparts who receive office-based or hospital-based infusions, a recent study suggests.

Researchers examined records from the Optum Clinformatics Data Mart on 27,396 patients with inflammatory bowel disease (IBD) who received infliximab from 2003 to 2016. The primary endpoints were treatment discontinuation and nonadherence, which researchers defined as having two or more infusions that were more than 10 weeks apart within a one-year period.

Overall, 5.7% of the patients used home infliximab infusions, and the study found that 22.2% of them were nonadherent to treatment and 44.7% discontinued infliximab. Nonadherence rates were lower for other patients (19.8% and 21.2% for office-based and hospital-based infusions, respectively) and so was discontinuation (33.7% and 33.4%, respectively).

On Kaplan-Meier analysis, the probability of patients remaining on treatment by 200 days was 64.4% for home-based infliximab infusions, compared with 74.2% and 79.3% for hospital-based and office-based infusions, respectively.

"What we have been seeing in clinical practice is that insurance companies are increasingly mandating where patients receive infusions, since hospital-based infusions are much more costly due to the non-drug costs associated with the services rendered," said senior study author Dr. K.T. Park, senior study author and an IBD Specialist at Packard Children's Health Alliance and Stanford Health Care in California.

"Our study calls into question whether we may be compromising quality of care when patients with IBD -- at a population level -- receive biologics at home compared to health care facilities, such as a doctor's office or the hospital," Dr. Park, also an employee at Genetech Inc. in California, said by email.

Home-based infusions were also associated with higher costs, researchers report in the American Journal of Gastroenterology. Overall annual care costs based on total paid claims per member per year were $49,149 for home infusions compared with $43,466 for office-based infusions.

With home-based infusions, patients also had the fewest follow-up visits with primary gastroenterologists per year, at 2.7, and more hospitalizations and emergency department visits than people on office-based infusions.

In addition, home-based infusion use was associated with more mean days of corticosteroid use, at 238.2 per year compared with 189.7 days with office-based infusions.

Among a subsample of 1,839 pediatric patients younger than 18 years of age, 12.1% received home-based infliximab infusions. These patients were more likely to be nonadherent than patients with office-based or hospital-based infusions, and they were also more likely to discontinue treatment than patients on office-based infusions.

The researchers were unable to account for disease severity or phenotype matching in their analysis. Also, the Optum database doesn't include patients with government subsidized insurance, and many children with special needs are covered by government supported health programs.

"While home infusions may provide convenience and cost-savings for some patients, they may also be associated with decreased durability of infliximab, increased IBD-related ER visits and hospitalizations, increased steroid use, and decreased outpatient GI followup in others," said Dr. Benjamin Cohen of the Digestive Diseases and Surgery Institute at the Cleveland Clinic in Ohio. Dr. Cohen has received consulting fees from Abbvie, Target PharmaSolutions and Sublimity Therapeutics.

"Patients on home infusion of infliximab should be carefully monitored to avoid these potentially adverse outcomes," Dr. Cohen, who wasn't involved in the study, said by email. "Standardization of home infusion practices and monitoring programs may optimize home infusion care to balance the cost benefits with safe, effective care of our patients."

SOURCE: https://bit.ly/3b1tPKG American Journal of Gastroenterology, online July 22, 2020.