Premedication Use Before Infliximab Administration

Abstract

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.

Rapid Infliximab Infusion in Children with Inflammatory Bowel Disease

“…Only 20% did not routinely use premedications and 18% identified the potential association of diphenhydramine use with increased reactions. 9 Previous data have suggested that administration of antihistamines, alone or in combination with corticosteroids and/or antipyretics, might be paradoxically associated with higher rates of immediate IRs. 10,11 This finding is obviously discordant from our findings; however, this difference again could be related to possible selection bias.…”

Risk Factors Associated with Infusion Reactions to Infliximab in Chinese Patients with Inflammatory Bowel Disease: A Large Single-Center Study

“…All the patients in our study were given pretreatment routinely with intravenous corticosteroids before each IFX infusion. However, high inter-practice and intra-practice variability for premedication use exits before IFX administration in different centers in Western countries [21]. The clinical rationale for premedicating patients seems to be driven by individual preference or group practice habit [21].…”

“…However, high inter-practice and intra-practice variability for premedication use exits before IFX administration in different centers in Western countries [21]. The clinical rationale for premedicating patients seems to be driven by individual preference or group practice habit [21]. In contrast, data from the Mayo Clinic found that in the adult population, premedication was not associated with a reduced risk of recurrent IR [15].…”

Comparison of Two Corticosteroid Pre-Infusion Regimens for Pegloticase in the United States: A Retrospective Analysis in Community Rheumatology Practices

“…Methylprednisolone has been given as a pre-infusion prophylaxis corticosteroid prior to the administration of other infusion biologic therapies, including infliximab and rituximab [7]. While hydrocortisone remains widely used by rheumatology practices as a pre-infusion prophylaxis for pegloticase, some providers use methylprednisolone as an alternative corticosteroid.…”