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


METHODS
Fourteen 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.


RESULTS
Ten 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.


CONCLUSIONS
Our 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.
Duburque
C
C
Department of Hepato-Gastroenterology, CHRU of Lille, Lille Cedex, France.
Lelong
J
J
Iacob
R
R
Seddik
M
M
Desreumaux
P
P
Fournier
C
C
Wallaert
B
B
Cortot
A
A
Colombel
J-F
JF
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D002985:Clinical Protocols; D003424:Crohn Disease / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000209:etiology; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced; D000069285:Infliximab; D007262:Infusions, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab