Switching from intravenous to subcutaneous infliximab in Behçet's disease: feasibility, safety and early outcomes

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OBJECTIVES: To assess the feasibility on remission maintenance, safety and patient acceptance following switching from intravenous (IV) infliximab (IFX) to subcutaneous (SC) IFX in patients with Behçet's disease (BD) in sustained remission. METHODS: We conducted a multicentre, retrospective observational study across four Italian referral centres. Patients with BD in stable remission on IV-IFX were transitioned to SC-IFX (120 mg every two weeks). Inclusion criteria were age ≥18 years, fulfilment of the International Criteria for Behçet's Disease (ICBD), at least 12 months of prior IV-IFX therapy, and a minimum of six months of SC-IFX treatment. Clinical and laboratory variables, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Behçet's Disease Current Activity Form 2006 (BDCAF 2006), prednisone use, and adverse events, were monitored longitudinally. Patient experience was assessed through the Self-Injection Assessment Questionnaire (SIAQ). RESULTS: Ten patients were included (median age 44 years; 60% male). Median IV-IFX duration before switch was 83.5 [IQR 24.7-145.3] months, median post-switch follow-up was 15.5 [IQR 7.50-19.00] months. Across follow-up, CRP, ESR, and BDCAF 2006 did not show major changes. Two relapses occurred, and both patients resumed IV therapy. Prednisone use decreased from 50% to 20%. Infections occurred in three patients. No significant systemic adverse events were reported. Patient feedback among respondents was generally positive, with high satisfaction scores regarding ease of use, self-confidence, and quality of life improvement associated with SC administration. CONCLUSIONS: Switching stable BD patients from IV to SC-IFX was feasible and well-tolerated, with preliminary signals suggesting that disease control may be maintained in many patients.

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