title: Administration of infliximab in general practitioners' offices is safe.
abstract: Infliximab is used in the treatment of various diseases, such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PA), Crohn's disease (CD) and ankylosing spondylitis (AS). In most countries, infliximab is given in hospitals or infusion centers, which are experienced in the management of infusion reactions. Because of this side effect, general practitioners (GPs) might refuse to administer infliximab in their offices. The aim of this study was to investigate the safety of infliximab administration in GPs' offices. Health system in the provincial state of Upper Austria (Austria) provides reimbursement of biological treatment only in outpatient care. Infliximab is due to cost effectiveness usually administered by GPs after a specific training and initialisation of treatment by specialists in the hospital. We sent out a form to 42 cooperating GPs, containing 20 questions concerning the administration of infliximab. Thirty-four forms were returned and evaluated. Altogether, 69 patients (2 patients per doctor mean) were treated with infliximab (1-42 months; 21 months mean). The overall observation period was 697 patients-months. During this period, 487 infusions (14.5 infusions per doctor mean) were administered. From five doctors, seven adverse events (AE) in six patients were reported. In all seven cases, infusion was discontinued; two had allergic reactions and five had nausea or cardiac symptoms, not definitely of allergic origin. Severe adverse events (SAE), defined as shock, emergency treatment or hospitalisation during or after infliximab administration were reported by two doctors. In contrast, SAE during the infusion of other drugs (e.g. analgetics, vitamins) were previously seen by 16 doctors, showing the overall possibility of infusion reactions with commonly prescribed drugs. Almost all (31/34) confirmed the overall safety of infliximab administration in GP's patient care. The administration of infliximab by specially trained general practitioners with background guidance through rheumatologist or gastroenterologist centers seems to be a safe and acceptable way to provide long-term treatment with infliximab to patients in need of biological treatment.
authors.affiliation: 2nd Department of Medicine, Section of Rheumatology, General Hospital Linz, Krankenhausstr. 9, 4020, Linz, Austria. ulrike.stuby@akh.linz.at
authors.forename: Ulrike
authors.initials: U
authors.lastname: Stuby
authors.forename: Georg
authors.initials: G
authors.lastname: Biesenbach
authors.forename: Herwig
authors.initials: H
authors.lastname: Pieringer
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy; D004334:Drug Administration Schedule; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects*; D000069285:Infliximab; D007262:Infusions, Intravenous; D010045:Outpatients; D005791:Patient Care; D010821:Physicians, Family; D012449:Safety; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D000069285:Infliximab