Onset of the COVID-19 Pandemic Did Not Impact Adherence to Infliximab Among IBD Patients

Introduction: The onset of the COVID-19 pandemic caused numerous disruptions in patient care; however, per expert opinion and early guidance from national GI societies IBD patients were encouraged to continue biologic therapy. The goal of this study was to assess adherence to infliximab (IFX) among IBD patients during the pandemic to their infusion schedule, associate adherence rates with need for steroids and IBD-related hospitalization and identify factors associated with non-adherence. Methods: We performed a single center retrospective cohort study at the University of Wisconsin-Madison. IBD patients ordered to receive IFX from 1/1/19 to 12/31/20 were included. Two pandemic periods (PP) were assessed: 1/1/20-6/30/20 (PP1) and 7/1/20- 12/31/20 (PP2) to evaluate the effect of different phases of the pandemic on infusion adherence. Adherence to therapy was defined as receiving IFX within 14 days of the scheduled date. The primary outcome was the rate of adherence during each time period. Secondary outcomes included corticosteroid prescriptions and IBD-related hospitalizations at 3- and 12-months after the first missed infusion appointment for each specified time period. Comparisons were made between 2019 (reference period) and the two PPs using chi-squared or Fisher’s exact tests. Comparisons between groups and continuous data were done using ANOVA or non-parametric Wilcoxon sign rank tests. Predictors of non-adherent events and secondary outcomes were assessed using a univariate and multivariate logistic regression model. Results: A random sample of 189 patients receiving IFX in 2019, 168 patients in PP1 and 167 patients in PP2 was analyzed. There were no differences in rates of adherence in the time periods or in corticosteroids required or IBD-related hospitalizations at 3 or 12 months after a non-adherent event (Table 1). Positive predictors of non-adherence included patient (OR 3.04, 95% CI [1.52-6.11), P=0.002) and infusion center related (OR 5.34, 95% CI [1.25-22.79], P=0.02) reasons for cancellation. Positive predictors of secondary outcomes included biologic discontinuation, biologic dose change and a biologic new start during the time period. Conclusion: The onset of the COVID-19 pandemic did not significantly impact rates of adherence to IFX among IBD patients suggesting that messaging efforts to not disrupt biologic therapy during the pandemic was successful. There were no differences in rates of corticosteroids and IBD-related hospitalizations. Table 1. - Infliximab Rates of Adherence and Associated Negative Outcomes Variable ControlsN = 189 Pandemic Period 1N = 168 Pandemic Period 2N = 167 P (All) P (Jan 2020 vs. Jul 2020) Missed appointment 14 days or longer No 174 (92.1) 157 (93.4) 154 (92.2) 0.87 0.66 Yes 15 (7.9) 11 (6.6) 13 (7.8) Hospitalization within 3 months No 181 (95.8) 165 (98.2) 161 (96.4) 0.41 0.31 Yes 8 (4.2) 3 (1.8) 6 (3.6) Hospitalization within 12 months No 178 (94.2) 162 (96.4) 159 (95.2) 0.62 0.60 Yes 11 (5.8) 6 (3.6) 8 (4.8) Corticosteroids within 3 months No 170 (90.0) 157 (93.4) 153 (91.6) 0.49 Yes 19 (10.1) 11 (6.6) 14 (8.4) Corticosteroids within 12 months No 161 (85.2) 152 (90.5) 149 (89.8) 0.23 083 Yes 28 (14.8) 16 (9.5) 17 (10.2) *Statistically significant at p≤0.05 Controls (Jan 2019 – Dec 2019), Pandemic period 1 (Jan 1, 2020, to June 2020), Pandemic period 2 (June 2020 to Dec 2020).