[Efficacy of premedication with intravenous corticosteroids and antihistaminics in preventing infusion reactions to infliximab].
OBJECTIVE
Infliximab can provoke acute or delayed infusion reactions (IR) leading to treatment withdrawal. Our aim was to determine the frequency of IR in patients with inflammatory bowel disease receiving intravenous infliximab and premedicated with steroids and antihistaminics.


METHODS
We prospectively studied 100 consecutive patients (74 with Crohn's disease, 26 with ulcerative colitis) treated with infliximab induction therapy (3 doses: weeks 0-2-6), followed or not by maintenance every 8 weeks. All patients were premedicated with 100 mg i.v. hydrocortisone and 5 mg i.v. dexchlorpheniramine 30 min before each infusion.


RESULTS
The mean age was 40.9+/-13 years (51% females, and 38% smokers). Ninety-two percent of the patients were under immunomodulator therapy (azathioprine/ mercaptopurine 85% or methotrexate 7%). A total of 560 infusions were administered, with a mean of 5.6 per patient (range, 1-21). Fifty-six percent of the patients received maintenance therapy. The mean length of follow-up was 17+/-16 months. IR occurred in 6 patients (6%) and in 1.4% of all infusions (8/560). All reactions were mild or moderate. Five IR were immediate, occurring in the second infusion. One IR was delayed (exanthema 5 days after the second infusion). Infliximab therapy was discontinued in only 3 patients (in the patient with the delayed IR and in 2 patients with immediate IR that reappeared during the third infusion).


CONCLUSIONS
In patients with inflammatory bowel disease treated with infliximab and under immunomodulator therapy, premedication with steroids and antihistaminics was associated with a low prevalence of IR. Moreover, after close follow-up, infliximab had to be discontinued in only 3% of the patients.
Bermejo
Fernando
F
Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Madrid, Spain. fbermejos@medynet.com
López San Román
Antonio
A
Algaba
Alicia
A
van Domselaar
Manuel
M
Carneros
José A
JA
Rivero
Miguel
M
Piqueras
Belén
B
Valer
M Paz
MP
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D002744:Chlorpheniramine / Q000008:administration & dosage*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D000069285:Infliximab; D007275:Injections, Intravenous; D008297:Male; D011292:Premedication; D011446:Prospective Studies
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D006634:Histamine H1 Antagonists; C018904:dexchlorpheniramine; D002744:Chlorpheniramine; D000069285:Infliximab; D006854:Hydrocortisone