Treatment persistence and efficacy of subcutaneous infliximab monotherapy in patients with inflammatory bowel disease: a real-world setting

Background and aims Subcutaneous infliximab (SC-IFX) offers an alternative to intravenous therapy with potential advantages in treatment persistence, medication burden and patient adherence. This study evaluated 12-month treatment persistence along with clinical, biochemical and endoscopic outcomes among patients with inflammatory bowel disease (IBD) established on SC-IFX monotherapy. Methods A retrospective observational cohort study was conducted at a tertiary centre. Baseline clinical (Crohn’s Disease Activity Index or partial Mayo score), biochemical (C reactive protein (CRP), albumin, haemoglobin, faecal calprotectin, IFX trough levels) and endoscopic data were collected at SC-IFX commencement and on follow-up at 12 months. Logistic regression analysis was used to identify predictors of treatment discontinuation. Results 101 adult patients were on SC-IFX monotherapy, 57 (56.4%) had Crohn’s disease and 44 (43.6%) had ulcerative colitis. Treatment persistence at 12 months was 91.1% (92/101), with sustained or improved clinical (100/101, 99.0%), biochemical (CRP (87/101, 88.1%), albumin (97/101, 96.0%), haemoglobin (100/101, 99.0%), faecal calprotectin (87/95, 91.6%), infliximab trough levels (86/94, 91.5%)) and endoscopic (90/93, 96.8%) outcomes at 12 months. Multivariate regression analysis only identified prior ileal resection as an independent predictor of treatment discontinuation at 12 months. Conclusion SC-IFX monotherapy demonstrated high treatment persistence along with maintenance or improvement of clinical, biochemical and endoscopic outcomes at 12 months. These findings provide encouraging real-world evidence supporting SC-IFX monotherapy as an effective IBD treatment option. Larger studies with longer follow-up are required to identify predictors of treatment discontinuation.