Appropriate infliximab infusion dosage and monitoring: results of a panel meeting of rheumatologists, dermatologists and gastroenterologists

Abstract

Infliximab is an effective treatment for rheumatoid arthritis, ankylosing spondylitis, Crohn's disease (both adult and paediatric), ulcerative colitis, psoriatic arthritis and plaque psoriasis and national and international guidelines have been developed for each indication. WHAT THIS STUDY ADDSThis study is the first study which compared current international, national and local guidelines from the medical specialties involved in the treatment with infliximab on the following topics: indication, dosage, synergy and monitoring of vital signs. AIMSInfliximab, an anti-TNF biologic agent, is currently indicated and reimbursed for rheumatoid arthritis, ankylosing spondylitis, Crohn's disease (both adult and paediatric), ulcerative colitis, psoriatic arthritis and plaque psoriasis. Development of national and international guidelines for rheumatology, gastroenterology and dermatology, was mostly based on clinical studies and expert opinion.The aim of this study was to compare available guidelines and local protocols for rheumatology, dermatology and gastroenterology, regarding dosage of infliximab, synergy of infliximab with concomitant medication and monitoring of vital signs during infliximab administration, for achieving optimal care. METHODSCurrent international, national and local guidelines on the use of infliximab were reviewed and compared, differences and shortcomings were identified, and optimal treatment schedules discussed during a meeting (July 2008) of clinical experts and researchers from three departments of a Dutch university hospital. RESULTSRecommended dosages of infliximab are not equal for different indications. Loss of response to infliximab is a common problem encountered within the three medical specialties, but indications for adjustments in treatment schedules are lacking in all of the guidelines. Monitoring of vital signs (blood pressure, pulse, temperature) during infusion with infliximab is common practice and recommended by some guidelines. Routine measurement of vital signs is not of any value in predicting or recognizing acute infusion reactions, in our experience, and this is confirmed by literature on inflammatory bowel disease. CONCLUSIONDifferent indications encompass different dosing schedules. National and internal guidelines do not provide advice regarding loss of response. Routine measurement of vital signs during infusion is not valuable in detecting acute infusion reactions and should only be performed in case of an acute infusion reaction. These topics need to be studied in future studies and covered in future guidelines.

Practical guidance on immunogenicity to biologic agents used in the treatment of psoriasis: What can be learnt from other diseases?

“…However, concomitant immunosuppression (e.g. azathioprine, methotrexate) is generally recommended in IBD but not in psoriasis (38).…”

Monitoring ankylosing spondylitis: clinically useful markers and prediction of clinical outcomes

“…Vital parameters such as blood pressure, pulse frequency and body temperature are usually assessed and documented during infliximab infusions, but to date no study has shown that the routine measurement of vital signs can better predict, help to recognize or handle infusion reactions to infliximab. An expert panel of rheumatologists, dermatologists and gastroenterologists has recommended measuring vital signs at baseline to rule out possible infections or other contraindications before the administration of infliximab, and to only provide the therapy in centers and units trained to handle infusion reactions [92].…”

Efficacy and Safety of Adalimumab Long-Term Administration with Immunosuppressants at Juvenile Idiopathic Arthritis without Systemic Manifestations

“…[11]. Основным преимуще-ством биологической терапии является максимальная избирательность воздействия на иммунную систему, позволяющая устранить необходимое звено в патогене-тической цепи, не воздействуя на клетки других органов и систем [12].…”

“…[11]. Основным преимуще-ством биологической терапии является максимальная избирательность воздействия на иммунную систему, позволяющая устранить необходимое звено в патогене-тической цепи, не воздействуя на клетки других органов и систем [12].Центральное звено в патогенезе ЮИА без систем-ных проявлений -фактор некроза опухоли (ФНО) ␣. Он обладает цитотоксическими, иммуномодулирующими и провоспалительными свойствами, обусловливая хро-ническое воспаление, деструкцию хряща и кости, потерю костной массы [13].…”