Intravenous Versus Subcutaneous Infliximab in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

Area of Science:

• Gastroenterology and Immunology
• Pharmacology and Therapeutics

Background:

• Subcutaneous (SC) infliximab offers potential advantages over intravenous (IV) formulations for inflammatory bowel disease (IBD) management.
• Previous studies on SC infliximab efficacy and safety in IBD were limited by small sample sizes, hindering subgroup analysis, especially for high-risk patients.

Approach:

• A systematic review and random-effects meta-analysis was performed, analyzing data up to January 2023.
• The study evaluated the change in clinical remission rates after transitioning IBD patients from IV to SC infliximab.
• Relative risk was used as the primary outcome measure to assess remission maintenance.

Key Points:

• Analysis included 15 studies with 1371 patients established on IV infliximab for at least 3 months.
• No significant loss of clinical remission was observed overall, in Crohn's disease (CD), or perianal CD patients.
• Neither prior IV dose escalation (≤10 mg/kg 6-weekly) nor IBD disease subtype (UC vs. CD) correlated with increased relapse rates at 6 months.

Conclusions:

• Transitioning from IV to SC infliximab in IBD patients demonstrates sustained clinical remission and a low adverse event profile.
• No increased risk of adverse outcomes was identified in specific IBD subtypes or in patients previously on escalated IV infliximab doses.
• These findings support the confidence of patients and clinicians in utilizing SC infliximab for IBD treatment.