Successful induction of tolerance to infliximab in patients with Crohn's disease and prior severe infusion reactions

Abstract

SUMMARY AimTo appraise the tolerance and efficacy of an induction of tolerance protocol to infliximab permitting the re-administration of the drug to patients with Crohn's disease having had infusion reactions requiring suspension of treatment. MethodsFourteen patients were included in the induction of tolerance protocol. Each infusion of infliximab (5 mg/kg) was divided into 11 escalating 15 min increments over a 3-h time period. The induction of tolerance procedure was repeated for subsequent infusions. ResultsTen patients (71.4%) received all the three infusions for the induction treatment. Nine (64.3%) had a significant response and six (48.8%) still benefited from infliximab infusions. Seven patients (50%) achieved a complete remission, after a mean of 2.5 (two to three) infusions. Four patients (28.6%) had no response and the protocol was stopped. Three patients (21.4%) experienced mild immediate hypersensitivity reactions, which were controlled, two patients (14.2%) experienced severe immediate hypersensitivity reactions, leading to interruption of the treatment and one patient developed a delayed hypersensitivity reaction. ConclusionOur induction of tolerance protocol allows some patients who have experienced severe or repetitive infusion reactions to infliximab to be safely retreated with the drug in a hospitalized setting, with a clinical response achieved in a majority of these patients.

Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment

“…This process has been invaluable in allowing the use of life-saving and disease-modifying medications in situations in which there is no acceptable treatment alternative. Desensitization has been described in case reports or small series for rituximab, 27 infliximab, [28][29][30] trastuzumab, 31,32 muronomab, 33 cetuximab, 34 and omalizumab. 12 No desensitizationrelated deaths have been reported.…”

Allergy to monoclonal antibodies: cutting-edge desensitization methods for cutting-edge therapies

“…In 2006, Duburque et al reported their experience with desensitization in 14 patients with Crohn's disease who had developed infusion reactions despite prophylactic administration of hydro cortisone [17]. The protocol was specifically for patients with severe infusion reactions for whom the continuation of infliximab therapy was considered as the only therapeutic option.…”

Efficacy and Safety of Infliximab Tolerance Induction in Patients with Inflammatory Bowel Diseases who Experienced Acute Infusion Reactions

“…Initially, Puchner et al [14] published in 2001 a successful induction of tolerance to IFX in 2 cases including a child, with prior anaphylactic reaction. Later, Duburque et al [15], Mourad et al [17], and Brennan et al [16] reported the successful induction of tolerance to IFX in, respectively, 10, 12, and 6 patients with CD and various other autoimmune diseases. More recently, a study evaluating the impact of IgE antibodies detection in the management of IFX retreatment showed an efficient induction of tolerance in 3 out of 4 patients [13].…”