title: The impact of infliximab infusion reactions on long-term outcomes in patients with Crohn's disease.
abstract: BACKGROUND
  Little is known about long-term outcomes in patients who experience infusion reactions while receiving infliximab.
  
  
  OBJECTIVE
  To investigate long-term outcomes in patients who experience infusion reactions while receiving infliximab.
  
  
  METHODS
  Retrospective electronic chart review of long-term clinical outcomes.
  
  
  RESULTS
  Clinical data on 287 patients who received infliximab infusions for Crohn's disease were reviewed, of whom 51 developed at least one infusion reaction (18%). Ileo-colonic disease (OR 2.2, 95% CI 1.1-4.4) and episodic infliximab (OR 2.4, 95% CI 1.2-4.7) were associated with a higher risk of infusion reactions in univariate analysis, but concomitant azathioprine/mercaptopurine therapy at the initiation of infliximab was associated with a reduced risk (OR 0.4, 95% CI 0.2-0.8). Only the effect of concomitant immunomodulators persisted on multivariate analysis. Patients who experienced infusion reactions were less likely to be in remission at 1 year (OR 0.6, 95% CI 0.3-1.2), 2 years (OR 0.4, 95% CI 0.2-0.8, P = 0.01), or 5 years (OR 0.4, 95% CI 0.1-1.3) and more likely to require surgery (OR 2.2, 95% CI 1.1-4.1, P = 0.01) than those who did not experience such reactions.
  
  
  CONCLUSIONS
  Patients who experienced infusion reactions to infliximab had a high rate of discontinuation of therapy in this cohort. Concomitant immunomodulators and maintenance therapy reduced the risk of infusion reactions.
authors.affiliation: Harvard Medical School, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. amoss@bidmc.harvard.edu
authors.forename: A C
authors.initials: AC
authors.lastname: Moss
authors.forename: N
authors.initials: N
authors.lastname: Fernandez-Becker
authors.forename: K
authors.initials: K
authors.lastname: Jo Kim
authors.forename: D
authors.initials: D
authors.lastname: Cury
authors.forename: A S
authors.initials: AS
authors.lastname: Cheifetz
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects*; D006801:Humans; D000069285:Infliximab; D007263:Infusions, Parenteral / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab