Home Biologic Infusions Linked to Increased Hospitalization Rates

A new study shows an increase in same or next day admissions in patients who opt for home infusions.

Investigators from Stanford University found that patients who were administered biologic infusions for immune-mediated diseases at home rather than a facility were associated with increased adverse events, leading to an escalation of care.

The study was designed to uncover the rate at which at-home patients were experiencing reactions to infusions as opposed to patients treated in health care facilities. Infusion reactions have been known to occur in 7%-20% of all patients who use biologics.

Additionally, home infusions have become increasingly common with patients. The team attributes this shift to the growing expenses of biologics care.

Biologics accounted for 38% of total prescription drug sales in the United States in 2015, and 70% of the growth in drug spending from 2010-2015. Facility overhead contributed to 16% of overall cost of biologics, which lead some patients to opt for home infusions.

The team, lead by Matthew C. Baker, MD, also attribute the increase of home infusions to the shelter-in-place and social distancing that occurred during the COVID-19 pandemic. However, the increase in home infusions in recent years was not reflected in the administrative data used or the study, which was gathered from January 2007-December 2017.

The data used for the study was culled from the Optum Clinformatics Data Mart.

The cohort study group was comprised of 57,220 patients with immune-mediated diseases, all of which received 752,150 biologic infusions during the course of the study. The team also extracted data on the use of concomitant glucocorticoids that were used following infusion episodes.

A total of 34 078 infusions (4.5%) were administered at home and 718 072 infusions (95.5%) were administered at a facility. Between 2015 and 2017, there was an increase in home infusions from 3.8% to 7.2%.

A biologics administered varied between the 2 groups. The top 3 biologics administered at home were infliximab (20,653;60.6%), natalizumab (6693; 19.6%), and vedolizumab (2681 ;7.9%), and the top 3 biologics administered at a facility were infliximab (373,985; 52.1%), abatacept (110,371; 15.4%), and natalizumab (95,697; 13.3%).

At-home participants tended to be younger males with a lower comorbidity score than a majority of participants in facilities, while participants in facilities had lower glucocorticoid use.

The study showed that 4.4% of home infusion patients experienced same or next day admissions to an emergency department (ED) or hospital, as opposed to 3.5% of patients who received their infusions in a facility.

Additionally, a majority at-home patients had used either tocilizumab, vedolizumab, and infliximab, and their admissions into ED or hospitals occurred after the first infusion. A majority of admission for patients who received care in facilities occurred after the third infusion.

Home infusions were associated with a 25% increase in ED or hospital visits, which the team attributes to a variety of factors.

“We hypothesize that administration of biologics at home involves less intensive monitoring, less physician oversight, and lack of immediate access to urgent medical treatment in the event of an acute infusion reaction,” the team wrote. “This can result in delayed care and a more frequent need for escalation of care.”

Despite some limitations, such as the use of claims data, the study proved successful in determining the rate of admissions in both home and facility-based infusions. The team urged at home administrators and/or patients to develop a greater knowledge on the subject of infusions, and approach infusions with greater care, especially when tending to older patients.

“Rigorous assessment of the safety implications of administering biologic infusions at home is critical before they are expanded to older patients with more comorbidities and more severe immune-mediated disease,” the team wrote.

The study, “Comparison of Adverse Events Among Home- vs Facility-Administered Biologic Infusions, 2007-2017” was published online at JAMA Network