S2041 Enhancing Biologic Therapy Access in Inflammatory Bowel Disease: A Quality Improvement Initiative for Intravenous-to-Subcutaneous Transition

Introduction: Timely access to biologic therapy is essential for achieving treatment targets in inflammatory bowel disease (IBD). High demand for hospital infusions delays therapy, negatively impacting outcomes and straining resources. Subcutaneous (SC) infliximab and vedolizumab offer a crucial intravenous (IV) alternative, potentially alleviating systemic bottlenecks. We implemented a quality improvement (QI) initiative to transition eligible patients from IV to SC biologics, evaluating clinical outcomes and system efficiency. Methods: Conducted at a tertiary IBD center (May 2023-April 2024) using Plan-Do-Study-Act (PDSA) cycles. Maintenance IV infliximab or vedolizumab patients were assessed for SC transition based on disease stability, safety history, and consent. The intervention included structured education, shared decision-making, and clinical monitoring. Primary outcomes included clinical remission, persistence on therapy, and adverse events (AEs). Key system-level metrics: monthly infusion backlog, average biologic wait times, and total annual infusion burden. Results: Of 239 IBD patients receiving 1,855 IV infusions last year, 75 (31.4%) transitioned to SC therapy (20 infliximab, 55 vedolizumab). At 6-month follow-up, 85% maintained clinical remission; 15% had mild disease activity, half requiring SC vedolizumab every 10 days. Persistence on SC therapy was 100%. Adverse events occurred in 18%, primarily mild injection site reactions. Monthly infusion backlog decreased from 8–10 to 2–3 patients (65% reduction). Average biologic wait time decreased from 5–7 to 1–2 days (60–70% reduction). Overall, total infusion burden decreased by 21.2% in the subsequent year (from 1,855 to 1,461 infusions). Conclusion: This QI initiative demonstrated that transitioning IBD patients from IV to SC biologics is a safe, effective strategy to maintain outcomes while significantly improving system efficiency. Transitioning just 31.4% of patients resulted in a 21.2% reduction in total infusion burden and over 60% reductions in infusion backlog and wait times. These findings highlight SC biologics' scalability as a practical solution to optimize resource allocation, enhance patient experience, and streamline IBD care.