title: Predictors of infusion reactions during infliximab treatment in patients with arthritis.
abstract: In the present study we evaluated the impact of baseline antinuclear antibody (ANA) status and use of methotrexate on development of infliximab-related infusion reactions in patients with rheumatoid arthritis (RA) or spondylarthropathies (SpAs), including psoriatic arthritis. All patients with RA (n = 213) or SpA (n = 76) treated with infliximab during the period 1999-2005 at the Department of Rheumatology in Lund, Sweden were included. ANAs were present in 28% and 25% of RA and SpA patients, respectively. Because of differences in baseline characteristics, we used a binary logistic regression model to calculate odds ratios (ORs), adjusting for age, sex and prednisolone dosage. Altogether 21% of patients with RA and 13% of patients with SpA developed infusion reactions (P = 0.126). The OR for development of infusion reactions in RA patients with baseline ANA positivity alone was 2.1. Infliximab without methotrexate and infliximab as monotherapy were associated with ORs of 3.1 and 3.6, respectively. Combining infliximab without methotrexate and ANA positivity yielded an OR for infusion reaction of 4.6. Lower age at disease onset and longer disease duration were associated with infusion reactions (P = 0.012 and P = 0.036, respectively), but age, sex, C-reactive protein, erythrocyte sedimentation rate, Health Assessment Questionnaire and Disease Activity Score-28 at baseline were not. No predictors of infusions reactions were identified in SpA patients. RA patients treated with infliximab without methotrexate, and who are positive at baseline for ANAs are at increased risk for developing infliximab-related infusion reactions.
authors.affiliation: Department of Rheumatology, Lund University Hospital, Lund, Sweden. meliha.crnkic@med.lu.se
authors.forename: Meliha C
authors.initials: MC
authors.lastname: Kapetanovic
authors.forename: Lotta
authors.initials: L
authors.lastname: Larsson
authors.forename: Lennart
authors.initials: L
authors.lastname: Truedsson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sturfelt
authors.forename: Tore
authors.initials: T
authors.lastname: Saxne
authors.forename: Pierre
authors.initials: P
authors.lastname: Geborek
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D000974:Antibodies, Antinuclear / Q000097:blood*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001168:Arthritis / Q000097:blood / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy; D004342:Drug Hypersensitivity / Q000209:etiology; D005260:Female; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D025242:Spondylarthropathies / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D000974:Antibodies, Antinuclear; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab; D008727:Methotrexate