title: The safety of infliximab infusions in the community setting.
abstract: BACKGROUND
  Tumour necrosis factor-alpha (TNFalpha) has an important role in the pathogenesis of inflammatory conditions such as rheumatoid arthritis, Crohn's disease, ulcerative colitis and psoriasis. Infliximab, a chimeric anti-TNFalpha monoclonal antibody, has been shown to reduce the severity of symptoms or induces remission of active disease. Infusions have generally been limited to the hospital setting due to cost and concerns for patient safety. Studies defining its efficacy and safety have, therefore, originated almost exclusively from hospital settings.
  
  
  OBJECTIVE
  To evaluate the safety of infliximab in a community clinic environment, across all types of patients.
  
  
  METHODS
  A retrospective chart review of 3161 patients who received a combined 20,976 infusions at a network of community clinics over 16.5 months was conducted. Adverse drug reaction (ADR) information was retrieved and coded for time of onset, severity and outcome. Only ADRs that occurred during or within the first 24 h of the infusion were included.
  
  
  RESULTS
  A total of 524 (2.5% of all infusions) acute ADRs in 353 patients (11.2%) were recorded. Most reactions (ie, ADRs) were mild (n=263 [50.2%, 1.3% of all infusions]) or moderate (n=233 [44.5%, 1.1% of all infusions]). Twenty-eight reactions (5.3%, 0.1% of all infusions) were severe. Emergency medical services were called to transport patients to hospital for seven of the severe reactions, of which none required admission. As per pre-established medical directives, adrenaline was administered three times.
  
  
  CONCLUSIONS
  Infliximab infusions are safe in the community setting. Severe ADRs were rare. None required active physician intervention; nurses were able to treat all reactions by following standardized medical directives.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario. jducharme@aimhealthgroup.com
authors.forename: James
authors.initials: J
authors.lastname: Ducharme
authors.forename: Cindy
authors.initials: C
authors.lastname: Pelletier
authors.forename: Ramesh
authors.initials: R
authors.lastname: Zacharias
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab; D007262:Infusions, Intravenous / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011565:Psoriasis / Q000188:drug therapy*; D012189:Retrospective Studies; D012449:Safety; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab