Factors influencing acute infusion reactions in inflammatory bowel disease patients treated with infliximab in the era of scheduled maintenance therapy

Duron, Cédric; Goutte, Marion; Pereira, Bruno; Bommelaer, Gilles; Buisson, Anthony

doi:10.1097/meg.0000000000000354

Cited by 24 publications

(17 citation statements)

References 34 publications

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“…To minimize bias due to confounding by unknown ATI levels in our population, we used concomitant immunomodulatory therapy as covariate, as this significantly reduces ATI-forming [21]. Other studies also found an association between drug holidays and IR [9,16], but this could not be confirmed in our study.…”

Section: Discussionmentioning

confidence: 70%

“…No consensus exists on the exact definitions of IR [8], but most commonly described IR against IFX include pruritus, flushing, and dyspnea [2,5]. The evidence on risk factors for development of IR is however limited [9,10]. Premedication (PM), such as antihistamines and corticosteroids, has been considered to decrease the odds of developing IR [11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Premedication with intravenous steroids does not influence the incidence of infusion reactions following infliximab infusions in pediatric inflammatory bowel disease patients—a case-control study

Wassenaer

Meester

Kindermann

et al. 2019

Eur J Clin Pharmacol

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Purpose Infusion reactions (IR) are commonly described side effects of infliximab (IFX) infusions, often leading to discontinuation of IFX. This study aimed to investigate the influence of steroid premedication (PM) on incidence of IR in pediatric inflammatory bowel disease (PIBD) patients receiving IFX. Methods A case-control study in two tertiary centers in Amsterdam, The Netherlands, including PIBD patients receiving IFX. PM with steroids was part of standard care in one center (PM+) but not in the other center (PM−). Acute IR were divided into mild/severe reactions and in grade 1/2/3/4 for detailed exploration. Differences between subgroups were assessed with the T or chi-square test. Multivariate logistic regression was used to assess associations between PM and IR incidence, correcting for comedication usage. Results We included 226 patients (91 PM+, 50% male, mean age at onset of IBD 12.7 years), receiving 3433 infusions. There was no difference between the PM+ and PM− subgroups in incidence of IR (14.3% vs. 17.0% of patients, p = 0.58) and in percentage of infusions followed by IR (1.4% in both subgroups). The OR of developing IR when using PM was 1.06 (95% CI 0.49-2.27, p = 0.89), and the OR of developing a grade 3 or 4 IR when using PM was 0.90 (95% CI 0.24-3.39, p = 0.88) when correcting for co-medication usage. Conclusion The incidence of IR was low, and premedication with steroids did not decrease the incidence of IR in this cohort of PIBD patients receiving IFX. Our results indicate that PM with steroids is not indicated in PIBD to prevent IR.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Premedication with intravenous steroids does not influence the incidence of infusion reactions following infliximab infusions in pediatric inflammatory bowel disease patients—a case-control study

Wassenaer

Meester

Kindermann

et al. 2019

Eur J Clin Pharmacol

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“…13,14 Evidence also supports a non-immunologic basis for infusion reactions, 5,7,15 and experiential data show that the likelihood of acute infusion reactions does increase following a drug hiatus. 16 …”

Section: Introductionmentioning

confidence: 99%

“…14,15 Corticosteroids have shown no definitive difference in infusion reactions. 4,15,16,17,18,19 The incidence of reactions in the setting of immunosuppressive therapy is unclear; some studies show lower incidence; 4,9,11,17 others show no difference. 15,16 …”

Section: Introductionmentioning

confidence: 99%

Premedication Use Before Infliximab Administration

Picoraro

Winberry

Siegel

et al. 2017

Inflammatory Bowel Diseases

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Background Premedications are commonly given to inflammatory bowel disease (IBD) patients prior to intravenous infliximab administration. We aimed to (1) describe practice variability; and (2) determine clinician rationale for premedicating IBD patients prior to infliximab administration. Methods We developed a cross-sectional electronic survey after comprehensive literature review to assess practice variability and clinician rationale for premedication use prior to infliximab. An optional post-survey quiz assessed clinicians’ understanding of available literature. The survey was distributed through members-only NASPGHAN and Crohn’s and Colitis Foundation of America (CCFA) listservs and American Gastroenterological Association (AGA) and American College of Gastroenterology (ACG) web-based discussion boards. Results 379 unique respondents with a 93.3% survey completion rate comprised 331 (87%) and 45 (12%) pediatric and adult gastroenterologists. Among numerous options for premedications, acetaminophen (66%) and diphenhydramine (64%) were most often given prior to each infliximab infusion. Only 20% did not routinely use premedications. There was heterogeneity of premedication use between gastroenterologists within the same clinical practice. Of 328 (87%) respondents who completed the knowledge assessment quiz, only 18% identified the association of diphenhydramine use with increased reaction. Conclusion There is high inter- and intra-practice variability for premedication use prior to infliximab administration. Clinician rationale for premedicating patients appears to be driven by individual preference or group practice habit. Improved knowledge of the evidence may assist in decreasing over-use of premedications, particularly diphenhydramine.

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“…However, patients restarting infliximab after a drug holiday have been shown to be at higher risk of infusion reactions (odds ratio 24.9; P<0.001). 142 Predictors of response after re-initiation of infliximab include having stopped while in remission and using antimetabolite combination therapy at restart. 143 The systematic use of steroid premedication has not been shown to be beneficial during infliximab re-induction.…”

Section: Stopping or Reducing The Dose Of Anti-tnf Drugsmentioning

confidence: 99%

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

Cohen

Sachar

2017

BMJ

113

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The treatment of inflammatory bowel disease (IBD)-ulcerative colitis (UC) and Crohn's disease (CD)-has evolved beyond surgery with the introduction of biologic agents, primarily antibodies against mediators of inflammation and cell attraction. Anti-tumor necrosis factor (TNF) agents have been the first line treatment for moderate to severe ulcerative colitis and Crohn's disease for more than 15 years. During that time much has been learnt about how best to use these agents. This review will assess the evidence on how to optimize the use of anti-TNF agents; when and how to start treatment; how to monitor treatment and when to de-escalate it; and the potential adverse effects of these drugs. New and emerging treatments such as anti-attractants, anti-interleukins, and Janus kinase (JAK) inhibitors will also be discussed.

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Factors influencing acute infusion reactions in inflammatory bowel disease patients treated with infliximab in the era of scheduled maintenance therapy

Cited by 24 publications

References 34 publications

Premedication with intravenous steroids does not influence the incidence of infusion reactions following infliximab infusions in pediatric inflammatory bowel disease patients—a case-control study

Premedication with intravenous steroids does not influence the incidence of infusion reactions following infliximab infusions in pediatric inflammatory bowel disease patients—a case-control study

Premedication Use Before Infliximab Administration

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

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