Episodic Infliximab treatment induces infusion reactions

Are accelerated infliximab infusions safe in patients with inflammatory bowel disease?

“…There is ongoing debate as to the advantages of maintenance infusions over episodic therapy. Arguments against episodic infusions are the risk of antibody formation against infliximab and the risk of an increase in adverse reactions 28, 29. Our results support this argument, suggesting that those prescribed episodic infusions appeared to have a greater number of adverse reactions.…”

Severe infusion reactions to infliximab: aetiology, immunogenicity and risk factors in patients with inflammatory bowel disease

“…Risk of reaction was highest at 2nd infusion in a reinitiation series and particular high at 2nd infusion in the 2nd series. Previous studies have reported a protective effect of induction regimen and scheduled maintenance therapy, 3,24 increased risk after drug pause 24,28,29 and a tendency of higher frequency of reactions at the 2nd IFX infusion. 3,19,[24][25][26] Reporting of the importance of concomitant immunosuppression has been variable; some studies have found a protective effect 3, 6, 13, 25 while others have not.…”

Impact of prior irregular infliximab dosing on performance of long-term infliximab maintenance therapy in Crohnʼs disease†

“…Unfortunately, multiple reports have suggested that prolonged gaps in treatment may be associated with infusion reactions to drug following attempts at restarting therapy at distant timepoints. [7][8][9][10] Complementarily, our study highlights the second question, suggesting that early irregular exposure or interrupted dosing can lead to a higher rate of hospitalizations, surgeries, and work disability in addition to these other problems when compared to patients who continue regular scheduled maintenance dosing.…”

“…[1][2][3][4][5][6] Despite this clear benefit, unanswered questions remain regarding optimal dosing regimens, specifically the ability to stop and restart a drug due to the potential for immunogenicity [7][8][9][10] and loss of efficacy as well as long-term performance beyond 1 year. The FDA label for infliximab therapy was modified in 2002 to move away from episodic dosing and instead emphasize regularly scheduled maintenance infusions in individuals who have responded to initial treatment.…”

“…To date, studies evaluating the reinitiation of infliximab have focused on immunogenicity and antiinfliximab antibody formation as well as infusion reactions, but have not addressed the longterm efficacy of the drug in this setting. 7,8,12 Hospitalizations and surgeries account for the majority of the healthcare costs in patients with CD. 13,14 In addition to these direct health costs, another important indirect economic consequence of this chronic illness in an economically productive age-group is the cost attributable to lost work productivity and permanent work disability.…”