{
  "abstract": "There is regional and national variability in the use of routine prophylactic medications for the prevention of anaphylactic or drug reaction with biologic therapies in inflammatory bowel disease (IBD). 1 Increasing reports have demonstrated the safety of IFX without premedication and that routine use of steroids and antihistamine medications may be unnecessary.2 The benefits of discontinuing routine premedication would be the reduction in medication side effects, cost and time taken for infusion visits. We aimed to demonstrate that the number of infusion reactions would not increase without premedication and to assess the response of children and young people with IBD and their families to this change.Methods From the first of June 2024, premedication prescription was discontinued for patients attending the day unit at our specialist paediatric gastroenterology centre. We aimed to assess service user response to this change over two discrete two-month periods (June-July and August-September). These responses were collected through anonymised feedback forms. Participants were asked three questions in this way, with each question posing a ‘yes/no’ response and allowing free-text space for elaboration on these responses. Questions assessed if the user had been informed of the change, if their infusion had gone differently to previously and whether they had experienced anything different over the course of days after the infusion. Over this time a record was made of all infusions given on the day unit and adverse events were recorded. Medication costs were calculated using the British national formulary for children (BNFc). 3 Results A total of 175 infusions were recorded over the examined period and 35 questionnaires were completed. No reactions to infliximab were reported. Medication cost was calculated at an average value of £6.10 per visit; without nursing costs. This represents a saving of £1,067.5 over the four months examined.Thirty of the thirty-five respondents reported having been informed of the change in practice (86%). Eighteen respondents noted a change in the experience of having the infusion (51%) though the changes were largely positive with participants reporting decreased lethargy or drowsiness. Fifteen respondents (43%) reported noticing changes after the infusion and in the subsequent days. Comments reported participants having ‘more energy,’ being ‘less unwell’ and being ‘able to go to school’ after the infusion. Some responded noting ‘less appetite’ and a ‘sore arm’. The most commonly used words were proportionally represented in figure 1; a word cloud.Conclusions Discontinuation of premedication for infliximab infusions was safe, cost effective and positive experience for our patients. Keeping patients informed of changes to their treatment is important to the team, which was demonstrated in responses. An immediate and subsequent reduction in tiredness is a positive outcome for this group who attend infusions around school, college and employment and could facilitate reduction in missed days. As well as reducing cost, the withdrawal of additional intravenous medications has reduced nursing time and overall infusion time.Abstract OC4 Figure 1A word cloud demonstrating the most used words and phrases in participant feedbackReferences Lichtenstein L, Ron Y, Kivity S, Ben-Horin S, Israeli E, Fraser GM, Dotan I, Chowers Y, Confino-Cohen R, Weiss B. Infliximab-related infusion reactions: systematic review. Journal of Crohn’s and Colitis Sep 2015;9(9):806–815. https://doi.org/10.1093/ecco-jcc/jjv096 Nuñez FP, Quera R, Simian D, Flores L, Figueroa C, Ibañez P, et al. Infliximab in inflammatory bowel disease. Is premedication necessary? Gastroenterol Hepatol (Engl Ed). 2021;44(4):277–85. Available from: https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-english-edition--382-pdf-S2444382421001103&#8203;:contentReference[oaicite:0]{index=0}&#8203;:contentReference[oaicite:1]{index=1}.Joint Formulary Committee. British National Formulary (online) London: BMJ and Pharmaceutical Press <http://www.medicinescomplete.com> [Accessed on 21st October 2024]",
  "authors": [
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK"
      ],
      "name": "Mick Cullen"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK",
        "Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK"
      ],
      "name": "Zachary Green"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK"
      ],
      "name": "Kirstin Morris"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK"
      ],
      "name": "Joanna Himsworth"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK",
        "Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK"
      ],
      "name": "James John Ashton"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK"
      ],
      "name": "R Mark Beattie"
    }
  ],
  "title": "OC4 Discontinuation of premedication for infliximab infusions is well-tolerated, without adverse events, and cost-saving in paediatric inflammatory bowel disease",
  "uid": "64965db3-f9d7-5e2b-a3f5-00ecf84bf915"
}