Management of infusion reactions to infliximab in patients with rheumatoid arthritis or spondyloarthritis: experience from an immunotherapy unit of rheumatology.
OBJECTIVE
To suggest recommendations for management of acute infusion reactions induced by infliximab in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).


METHODS
In total, 203 patients were treated with infliximab (120 ml/h). Prevalence of acute infusion reaction was evaluated. To manage these conditions, recommendations were devised according to the type and the severity of clinical manifestations, which were classified beforehand in 2 groups: A (hypertension, pruritus, sudden flush, vomiting, tachycardia or bradycardia, shivers, fever) and B (urticaria, tickling throat, Quincke's edema, dyspnea, and hypotension). Recommendations were based mainly on adjustment of the infusion rate.


RESULTS
It was observed that 23/203 patients (11.3%) had acute infusion reactions. Among them and prior to our recommendations, infliximab was completely discontinued in 8/23 patients. After our recommendations were implemented, 15/23 patients presented an acute infusion reaction: 8 and 7 patients with symptoms of Group A and B, respectively. In Group A (8 patients), reducing the infusion rate to 60-80 ml/h led to disappearance of symptoms; the modified treatment was then maintained. In Group B (7 patients), the infusion was immediately stopped and appropriate drugs were administered. Once clinical manifestations were alleviated, the infusion was resumed (60 ml/h). Prior to subsequent infusions (60 ml/h), a premedication was administered.


CONCLUSIONS
Based on these recommendations, infliximab could be maintained with great efficacy on disease activity in every patient with an acute infusion reaction. Our recommendations permit sustained administration of infliximab and allow every patient to benefit from this therapy.
Lequerré
Thierry
T
Department of Rheumatology, Rouen University Hospital, Rouen, France. thierry.lequerre@univ-rouen.fr
Vittecoq
Olivier
O
Klemmer
Nathalie
N
Goëb
Vincent
V
Pouplin
Sophie
S
Menard
Jean-Francois
JF
Daragon
Alain
A
Mejjad
Othmane
O
Le Loët
Xavier
X
D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000517:prevention & control; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D017410:Practice Guidelines as Topic; D012219:Rheumatology / Q000379:methods*; D025241:Spondylarthritis / Q000188:drug therapy*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab