Biologic treatment is increasingly being administered at home because of both patient convenience and the higher costs associated with infusion at a facility. The safety implications of home infusions, however, aren't yet clear. In a study of adults with immune-mediated diseases, researchers assessed whether the administration of biologic infusions at home instead of at a facility was associated with an increase in adverse events requiring the escalation of care.

The retrospective study used claims data from a large national insurer. The study cohort comprised 57,220 adults who received 752,150 biologic infusions at home (34,078) or at a facility (718,072) during a 10-year period. Compared with patients who received infusions at a facility, those receiving home infusions were younger, more likely to be men, and had a lower mean Charlson comorbidity score.

Home infusions were associated with 25% higher odds of ED or hospital admission on the same or next day after the infusion and 28% higher odds of discontinuation of the biologic after an ED or hospital admission. Postinfusion mortality didn't differ between the two groups. The risk of ED or hospital admission was higher with home infusions of certain biologics-tocilizumab, vedolizumab, and infliximab-compared with facility infusions of these medications.

The study didn't adjust for background use of disease-modifying antirheumatic drugs, the authors note, adding that they didn't have data on preinfusion medications, prior infusion reactions, disease severity, or the primary indication for ED or hospital admission. They conclude that it's critical for the safety implications of biologic home infusions to be rigorously evaluated before this practice is expanded to include older patients who have more comorbidities and severe immune-mediated diseases.