718 The Experience of and Access to Rapid Infliximab Infusions at an Academic Tertiary Medical Center

Abstract

INTRODUCTION: Infliximab (IFX) induces and maintains remission in patients with inflammatory bowel disease (IBD) and rheumatologic disease (RD). It is time-intensive, which places great burden on patients and health systems. Rapid infusions (RI) reduce infusion time from 2 hours to 1 hour, theoretically can alleviate this burden and enhance access to care defined by effectiveness (safety), availability (capacity) and utilization (patient characteristics). We aimed to describe the RI experience at our center, with the hypothesis that RI enhance access to care for all patients regardless of indication for IFX. METHODS: All patients treated with IFX for IBD or RD at our outpatient infusion center from February 2016 to August 2017 were included. Demographic and clinical information including IFX indication, history of infusion reaction, use of pre-medication, number of standard and RI were collected. RESULTS: There were 348 patients, 212 (60.92%) were female, 193 (55.5%) had IBD and 143 (41.1%) had RD. In terms of safety, 21 (6%) had a history of infusion reaction, 7.8% with IBD and 3.5% with RD (P = 0.1127). 33.6% were premedicated for infusions. For only RD, a lower number receiving RI received pre-medications (P = 0.0002). The history of infusion reaction was 5.7% in the RI group and 6.3% in the standard infusion group (P = 1.000). Only 2 patients required switch back to standard infusion after reaction with RI. In terms of capacity, 40% of patients were converted to RI during the study period. This resulted in a 16.1% decrease in average daily infusion time and 9.8% increase in average daily available scheduled chair time or an additional 261.2 (±19.7) minutes per day (P = 0.72). In terms of patient characteristics, a larger number of RD patients received RI versus IBD patients (P = 0.0261). Only for the RD group a lower number of patients receiving RI were female (P = 0.0491). For patients with RD and IBD, a lower number of patients receiving RI versus standard infusions were on public insurance (P = 0.011 and P = 0.0151) and patients receiving RI had been on IFX for a longer period of time (P = 0.0002, P < 0.0001). CONCLUSION: RI were safe and increased available chair time. There were differences in patient characteristics: females with RD and public insurance patients were less likely to receive RI. Future directions include creation of a prospective registry and patient quality of life surveys to understand if implicit bias against disease, gender, socioeconomic status, or other factors impact access to RI.