PMO-27 Switching to subcutaneous vedolizumab in inflammatory bowel disease during COVID-19 pandemic – County Durham experience

IntroductionThe COVID-19 pandemic resulted in the need for significant adaptations to an intravenous biologics infusion service. Patients were reluctant to come to a Biologics Infusion Unit in an acute hospital due to the fear of exposure to SARS-CoV-2 virus and also due to the UK governmental advice on strict isolation and shielding. Based on the VISIBLE-1 and -2 Study data, we decided to switch our IBD patients from IV Vedolizumab to SC vedolizumab in a phased manner. We report on our experience and short term outcomes.MethodsDuring the COVID-19 pandemic, we decided to switch patients with Ulcerative colitis and Crohn’s disease from IV Vedolizumab to Subcutaneous Vedolizumab in a phased manner. In the first Phase (July – Sep 2020) all patients with Ulcerative colitis (UC) in clinical remission of their disease beyond 16 weeks of Vedolizumab treatment were invited to switch. In phase 2 (October –Dec 2020) additional UC and Crohn’s Disease (CD) patients on maintenance were switched and in Phase 3, new patients with UC and CD entering the Vedolizumab treatment programme were included for IV induction followed by SC maintenance. 6 month outcomes were assessed for clinical response, faecal calprotectin, and for short term patient experience.ResultsA total of 31 patients were switched in the 6 month period of COVID-19 adaptation. 19 patients had UC (13 pancolitis, 6 distal colitis) and 12 patients had CD (1 Crohn’s colitis, 5 ileocolonic, 5 small bowel and 1 complex). Over the 6month period, 1 patient flared on SC Vedo and switched back to escalated IV, 1 developed abnormal LFTs and switched out of class. All remaining patients were doing well, and had mean SCAI score of 0, HBI score of 1. Mean FCP in UC patients was 197 ug/g (range 25-561), and in CD patients was 248ug/g (range 213-283). Patient experience indicated that all patients on SC Vedo felt that they were safer during the pandemic.ConclusionA COVID-19 adaptation of managed switching of patients with ulcerative colitis and Crohn’s disease from IV to SC Vedolizumab is safe and does not result in any adverse outcomes. Long term data on maintenance of remission and endoscopic healing is awaited.