N04 How to manage the concerns of patients with inflammatory bowel disease due to the transition from in-hospital to home management with oral or subcutaneous therapies: results of a survey of a cohort of patients in intravenous biologic treatment

Background Therapeutic armamentarium of inflammatory bowel disease (IBD) has expanded, including several intravenous (IV) and subcutaneously administered biological agents and orally administered small molecules (SMs). Additionally, some biologics initially available only for IV administration also have subcutaneous (SC) formulations. However, transitioning from in-hospital IV treatment to SC or oral home therapy can lead to some patient concerns, mainly linked to the need for self-administration and managing side effects. This study aimed to evaluate the opinion of IBD patients on the transition to oral or SC treatment, considering multiple socio-demographic factors, the frequency of biologic agent infusion, and the commitments (personal, family, work) associated with the in-hospital administration of therapy. In addition, patients were asked about their knowledge of new therapeutic options and their expectations about this management modality. Methods We conducted a survey using a questionnaire prepared by a team of gastroenterologists and nurses working at the IBD Unit of the CEMAD-Policlinico Gemelli of Rome. The survey was administered to consecutive IBD patients in stable IV biological treatment from January to October 2022. It consists of 31 items and has been divided into four sections: descriptive, commitment, knowledge and passage mode opinion. Results 311 patients responded to the survey from 400 questionnaires (77.7%). 49.8% favored switching from IV to oral or SC therapy, and only 25.1% disagreed. In univariate and multivariate analysis, the home therapy approval rate was significantly associated with the distance from the IBD center (Fig. 1) and work/family/personal commitments. Surprisingly, only about a quarter of the IBD patients knew that almost all the following available therapeutic agents will have an SC administration route or will be SMs (Fig. 2). Regarding patients' opinion on the efficacy of SMs or SC administration of biological agents compared to IV drugs: 63% had no definite idea, while 14% believed that the effectiveness could be reduced. 23.8% of patients would like to be reassured by their gastroenterologist or nurse on the efficacy and safety of these new therapeutic options, and 7.7% would like to know the scientific data from studies on this issue. Conclusion The transition from in-hospital to the home therapeutic management of biological therapy with SC or oral agents was generally viewed favorably by patients, especially if they have commitments or are residents far from the IBD center. However, to reduce patient concerns and encourage this change, it is necessary to implement a patient training and information program involving all the IBD unit care figures, including IBD nurses.