{
  "abstract": "Infliximab is recommended for treatment of patients with severe active inflammatory bowel disease, those who have not responded to or are intolerant to conventional therapy 1 ESPGHAN recommends trough infliximab levels of 5-10 for maintenance treatment, with higher levels for perianal disease.2Within this paediatric tertiary centre there was an increasing clinical demand for patients commencing biologics. 31% of patients receiving intravenous infliximab were aged 16-18. Increasing biologic use resulted in 6-8 week waiting times for patients to start biologics due to limited capacity. Lack of day case capacity delayed discharge by up to 7 days in 4 patients at the time of review.Subcutaneous infliximab has been widely used since 2020 within the adult sector across Europe. Clinical advantages and positive impact on health-related quality of life were observed.3Subcutaneous infliximab has been shown to be non-inferior to IV infliximab from pharmacological and clinical perspectives.4 Safe switching from IV to subcutaneous infliximab whilst ensuring continued clinical remission has been demonstrated.5Whilst the majority of evidence is adult based, there has been a single centre cohort of paediatric patients evidencing clinical remission and therapeutic trough levels.6We aimed to evaluate a cohort of IBD patients switching from intravenous to subcutaneous infliximab. Inclusion criteria were post pubertal, >40kg, stable disease (inflammatory markers in range, asymptomatic, with therapeutic infliximab levels and no antibodies (with the exception of low levels due to difficult IV access). Suitable patients were identified from the IBD database and the virtual biologics clinic. Registration with the hospital’s Quality Improvement department was completed and approval granted from the hospital’s Medicines Management Committee.17 paediatric patients were switched with a mean age of 16.2. 15/17 had therapeutic levels, 2/17 had suboptimal levels but switched due to poor IV access. Patients received written information and verbal counselling in order to consent to the switch.Bloods including inflammatory markers and infliximab levels are obtained pre: 5th dose of subcutaneous infliximab. 5 patients in the study have not yet reached this period to have these bloods taken (see table 1).Clinical advantages were identified following the switch to subcutaneous infliximab, demonstrated by increased serum levels, efficacy outcomes, and reduction in IV access issues. Patient feedback identified the change has impacted positively on quality of life, improved access to treatment, and improved attendance in education.This change has also impacted the healthcare burden as this has reduced attendance to the daycase unit following induction. Whilst there is little difference in cost of subcutaneous infliximab compared to intravenous, there is a considerable saving through reduction in need for regular hospital attendance for drug administration.References NICE (2019). Recommendations | Crohn’s disease: Management | Guidance | NICE. [online] www.nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng129/chapter/Recommendations#maintaining-remission-in-crohns-disease.Turner, et al. Management of paediatric ulcerative colitis, part 2: acute severe colitis—an evidence-based consensus guideline from the European Crohn’s and Colitis organization and the European society of paediatric gastroenterology, hepatology and nutrition. JPGN 2018;67(2):292–310.Alten R, An Y, Kim DH, Yoon S, Peyrin-Biroulet L. Re-routing infliximab therapy: subcutaneous infliximab opens a path towards greater convenience and clinical benefit. Clin Drug Investig 2022 Jun;42(6):477–489. doi: 10.1007/s40261-022-01162-6. Epub 2022 Jun 3. PMID: 35657560.Stefan Schreiber, Shomron Ben-Horin, Jaroslaw Leszczyszyn, Robert Dudkowiak, Adi Lahat, Beata Gawdis-Wojnarska, Aldis Pukitis, Marek Horynski, Katalin Farkas, Jaroslaw Kierkus, Maciej Kowalski, Sang Joon Lee, Sung Hyun Kim, Jee Hye Suh, Mi Rim Kim, Seul Gi Lee, Byong Duk Ye, Walter Reinisch. Randomized controlled trial: subcutaneous vs intravenous infliximab CT-P13 maintenance in inflammatory bowel disease. Gastroenterol 2021;160(7):2340–2353. ISSN 0016-5085, https://doi.org/10.1053/j.gastro.2021.02.068.(https://www.sciencedirect.com/science/article/pii/S0016508521004741)Philip J Smith, et al. Efficacy and safety of elective switching from intravenous to subcutaneous infliximab [CT-P13]: a multicentre cohort study. J Crohn’s Colitis 2022 Sept;16(9):1436–1446. https://doi.org/10.1093/ecco-jcc/jjac053Gianolio L, Armstrong K, et al. Effectiveness of switching to subcutaneous infliximab in pediatric inflammatory bowel disease patients on intravenous maintenance therapy. J Pediatric Gastroenterol Nutr 2023 Aug 1;77(2):235–239. doi: 10.1097/MPG.0000000000003838. Epub 2023 May 23. PMID: 37219971.Abstract OC45 Table 1Infliximab levels and ESR pre and post switchPatientLevels pre switchLevels post switchESR pre switchESR post switchA1.417.32110B2.120.362C616.6069D8.514.8613E7.522.552F12.212.722G9.616.122H9.315.122I4.424.1170J4.213.91629K6.221.722",
  "authors": [
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Lisa Charlton"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Rebecca Foulkes"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Zain Butt"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Sian Copley"
    }
  ],
  "title": "OC45 The use of subcutaneous infliximab in a cohort of post-pubertal patients in a paediatric setting",
  "uid": "c05f47bc-ae5f-5cbc-959a-b77c01470bbf"
}