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N03 Can post biologic infusion monitoring be reduced? A mulit-centred retrospective study

L. Younge1, L. Whitley2, S. Azana3, L. Younge*4

1Royal London Hospital, GI Medicine, London, UK, 2University College London Hosptial, GI Services, London, UK, 3St Marks Hospital, GI Medicine, London, UK, 4Royal London Hosptial, GI Medicine, London, UK

Background

Increased availability of biologic medication to treat inflammatory bowel disease (IBD) is beneficial to patients but puts increased pressure on infusion clinic capacity. Facilitating infusions in a safe and timely manner has become difficult. Manufacturers of both infliximab (IFX) and vedolizumab (VDZ) recommend patients are monitored post infusion for defined periods, to observe for potential post infusion reactions. Ustekinumab has no recommended post infusion observation period. We wanted to explore if we could consider reducing all post biologic infusion times.

Methods

We retrospectively reviewed infusion data (IFX and VDZ) a 12 month period across three sites (Royal London Hospital-RLH, University College London Hospital- UCLH, St Marks Hospital- STM) from IBD CNS (clinical nurse specialist) led infusion clinics and identified incidence and timing of infusion reactions.

Results

4182 infusions of IFX for patients >18 years old (RLH n1152, UCLH n822, SMH n2208) were administered over the 12 month period. Sixteen infusion reactions were documented (0.4%) RLHn 9, UCLHn 3, SMHn 4. All reactions occurred within the first 20 min of the infusion starting. No infusion reactions were observed in the post infusion observation period. 2132 infusions of VDZ for patients > 18 years old (RLH n330, UCLH n626, SMH n1176) were administered over the 12 month period. Three infusion reactions were documented (0.14%) RLH n0, UCLH n2, SMH n1. All reactions occurred within the first 20 min of the infusion starting. No infusion reactions were observed in the post infusion observation period. In total patients were observed for 6665 h post infusion across the 3 sites for both IFX and VDZ.

Conclusion

We reviewed 6314 infusions (IFX n4182 VDZn 2132). Reactions occurred in n19 (0.3%) all within the first 20 min of the infusion starting. This suggests close monitoring of patients during the first 20 min is required. No reactions occurred within the manufacturers recommended post infusion observation period. This large multi -centre retrospective study demonstrates the risk of adverse reactions to either IFX or VDZ during the post infusion observation period is very rare. These findings suggest patients who have not had a reaction during their infusion do not routinely need post infusion observation. We hope to change practice by reducing the amount of time patients must spend being observed post infusion to enable a more efficient service whilst still providing safe and appropriate care.