Reacciones a la infusión de infliximab en pacientes dermatológicos

The Role of Fcγ Receptor Polymorphisms in the Response to Anti–Tumor Necrosis Factor Therapy in Psoriasis

“…Although patients were recruited in different hospitals and the outcome measures were evaluated by different physicians, all the evaluating physicians (J.M.C., C.F., and M.A.-G.) were members of the Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology and followed the same clinical criteria. 22 The ethics committees of the 2 hospitals approved the study protocol, and written informed consent was obtained from all participants before blood extraction for FcγR genotyping.…”

<p>The importance of early identification of infusion-related reactions to monoclonal antibodies</p>

“…Joint Task Force on Practice Parameters for drug allergy defined anaphylaxis as “an immediate systemic reaction that occurs when a previously sensitized individual is re-exposed to an allergen.”18 The characteristics of true anaphylactic reactions (type I IgE-mediated HR) are dyspnea and tightness of the chest, suffocation, hypotension, bronchospasm, and urticaria; in the absence of either of the latter two symptoms, it is unlikely that an acute reaction is anaphylactic, and it should thus be considered non-allergic 19,20. Since the first exposure to antigen is required for IgE sensitization, type I HR do not occur during the first administration of a mAbs infusion,21 except in rare cases where patients have pre-existing antibodies which cross-react with the drug 5,22…”

“…In dermatologic subjects with mild to moderate infusion reactions to infliximab, the prophylactic treatment of oral diphenhydramine and paracetamol should be administered at subsequent infusions, 90 mins before the start of each infusion. In patients who have manifested severe infusion reactions, pre-medication with IV hydrocortisone acetate 100 mg 20 mins before the infusion or with oral prednisone the day before the infusion is optional, according to the opinion of the clinician involved 19. Bartoli et al (2016) led a study which aimed to evaluate the incidence of IRRs in patients with joint inflammatory diseases (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) receiving treatment with infliximab with and without pre-medication.…”

“…Although recommendations or published protocols exist on the management of IRRs caused by some mAbs, such as infliximab in dermatologic patients,19 obinutuzumab in chronic lymphocytic leukemia patients,34 natalizumab in multiple sclerosis,9 much remains to be known about the correct way to manage IRRs. In addition to this, the lack of uniform terminology entails an obstacle for clinical practice.…”