Barriers, Drivers, and Outcomes in Transitioning Patients with Inflammatory Bowel Disease from Intravenous to Subcutaneous Infliximab

Background Data are limited on patients' experience of transition to subcutaneous treatment. This study aimed to determine what factors affect the decision to transition, to assess clinical outcomes and to elucidate patients' experience of transition. Methods This was a longitudinal, observational study carried out at University Hospital Galway, a tertiary referral center in Ireland, from November 2022 to December 2023. The drivers and barriers for patients eligible for transition were measured using a questionnaire with 21, 5-point Likert items. Clinical, biochemical, and patient-reported parameters were assessed at week 8 and week 26. Patients completed a survey at week 26 on their experience of treatment with subcutaneous Infliximab. Results Eighty of 144 eligible patients agreed to transition. Treatment persistence was 93.7% at week 26. There was no significant change in mean clinical, biochemical or patient-reported parameters at week 26. In multivariate analysis, there was higher probability of transition among patients with wholly publicly funded healthcare (OR = 3.53, 95% CI, 1.18-11.68). Among those who transitioned, the strongest drivers cited were lifestyle factors while among patients who declined transition, most commonly cited barriers included reduced contact with healthcare professionals. At week 26, 96.1% of respondents reported being able to contact the IBD team when necessary and 87.3% of respondents were satisfied with their monitoring. Conclusions Understanding patients' attitudes toward transition is essential to design a service that meets their needs. Services must be adequately resourced in order to ensure that patients treated with subcutaneous biologics continue to have ready access to high-quality care.