Infliximab in pediatric rheumatology patients: a retrospective analysis of infusion reactions and severe adverse events during 2246 infusions over 12 years.
OBJECTIVE
To describe infusion reactions (IR) and severe adverse events (SAE) associated with infliximab (IFX) in pediatric patients with rheumatologic and ocular inflammatory diseases in a real-world setting.


METHODS
This is a retrospective chart review of all patients treated with IFX at the pediatric rheumatology division of a university hospital between October 2000 and December 2012.


RESULTS
A total of 2446 IFX infusions were given to 82 patients (72% female). IR occurred in 46 infusions (2%) of 14 patients (17%) after a mean IFX treatment time of 340 days (range 41-780); 9/14 patients (64%) experienced repeated IR. IR were classified as mild (26%), moderate (74%), or severe (0%). Indications for IFX were arthritis (60%), uveitis (20%), arthritis and uveitis (13%), and other inflammatory diseases (5%). The most common clinical symptoms were respiratory signs (72%), cutaneous manifestations (69%), and malaise (61%). In 6/14 patients (43%) with IR, IFX was discontinued: 4 patients because of repeated IR and 2 patients wished to stop treatment immediately following a mild IR. The other 8/14 patients (57%) received premedication with high-dose antihistamine (100%), corticosteroids (75%), and IFX dose increase (75%) and continued IFX treatment for a mean followup period of 146 weeks (range 26-537) after the first IR. We observed severe infections in 5/82 patients (6%); other SAE were rare.


CONCLUSIONS
Mild and moderate IR occurred in 17% of our patients. Treatment with antihistamines and methylprednisolone, and increasing the IFX dose, allowed continued treatment despite IR in > 50% of patients. Other SAE were infrequent.
From the Department of Rheumatology, University Children's Hospital, Zurich; Ostschweizer Kinderspital, St. Gallen; and Department of Pediatrics, Kantonsspital Winterthur, Switzerland.F.A. Aeschlimann, MD, rheumatology fellow; K.D. Hofer, medical student; E. Cannizzaro Schneider, MD, staff pediatric rheumatologist; S. Schroeder, MD, staff pediatric rheumatologist, Department of Rheumatology, University Children's Hospital; R. Lauener, MD, professor, head of pediatric department, Ostschweizer Kinderspital; R.K. Saurenmann, MD, head of pediatric department, Department of Rheumatology, University Children's Hospital, and Department of Pediatrics, Kantonsspital Winterthur.
Florence A
FA
Aeschlimann
From the Department of Rheumatology, University Children's Hospital, Zurich; Ostschweizer Kinderspital, St. Gallen; and Department of Pediatrics, Kantonsspital Winterthur, Switzerland.F.A. Aeschlimann, MD, rheumatology fellow; K.D. Hofer, medical student; E. Cannizzaro Schneider, MD, staff pediatric rheumatologist; S. Schroeder, MD, staff pediatric rheumatologist, Department of Rheumatology, University Children's Hospital; R. Lauener, MD, professor, head of pediatric department, Ostschweizer Kinderspital; R.K. Saurenmann, MD, head of pediatric department, Department of Rheumatology, University Children's Hospital, and Department of Pediatrics, Kantonsspital Winterthur.
Kevin D
KD
Hofer
From the Department of Rheumatology, University Children's Hospital, Zurich; Ostschweizer Kinderspital, St. Gallen; and Department of Pediatrics, Kantonsspital Winterthur, Switzerland.F.A. Aeschlimann, MD, rheumatology fellow; K.D. Hofer, medical student; E. Cannizzaro Schneider, MD, staff pediatric rheumatologist; S. Schroeder, MD, staff pediatric rheumatologist, Department of Rheumatology, University Children's Hospital; R. Lauener, MD, professor, head of pediatric department, Ostschweizer Kinderspital; R.K. Saurenmann, MD, head of pediatric department, Department of Rheumatology, University Children's Hospital, and Department of Pediatrics, Kantonsspital Winterthur.
Elvira
E
Cannizzaro Schneider
From the Department of Rheumatology, University Children's Hospital, Zurich; Ostschweizer Kinderspital, St. Gallen; and Department of Pediatrics, Kantonsspital Winterthur, Switzerland.F.A. Aeschlimann, MD, rheumatology fellow; K.D. Hofer, medical student; E. Cannizzaro Schneider, MD, staff pediatric rheumatologist; S. Schroeder, MD, staff pediatric rheumatologist, Department of Rheumatology, University Children's Hospital; R. Lauener, MD, professor, head of pediatric department, Ostschweizer Kinderspital; R.K. Saurenmann, MD, head of pediatric department, Department of Rheumatology, University Children's Hospital, and Department of Pediatrics, Kantonsspital Winterthur.
Silke
S
Schroeder
From the Department of Rheumatology, University Children's Hospital, Zurich; Ostschweizer Kinderspital, St. Gallen; and Department of Pediatrics, Kantonsspital Winterthur, Switzerland.F.A. Aeschlimann, MD, rheumatology fellow; K.D. Hofer, medical student; E. Cannizzaro Schneider, MD, staff pediatric rheumatologist; S. Schroeder, MD, staff pediatric rheumatologist, Department of Rheumatology, University Children's Hospital; R. Lauener, MD, professor, head of pediatric department, Ostschweizer Kinderspital; R.K. Saurenmann, MD, head of pediatric department, Department of Rheumatology, University Children's Hospital, and Department of Pediatrics, Kantonsspital Winterthur.
Roger
R
Lauener
From the Department of Rheumatology, University Children's Hospital, Zurich; Ostschweizer Kinderspital, St. Gallen; and Department of Pediatrics, Kantonsspital Winterthur, Switzerland.F.A. Aeschlimann, MD, rheumatology fellow; K.D. Hofer, medical student; E. Cannizzaro Schneider, MD, staff pediatric rheumatologist; S. Schroeder, MD, staff pediatric rheumatologist, Department of Rheumatology, University Children's Hospital; R. Lauener, MD, professor, head of pediatric department, Ostschweizer Kinderspital; R.K. Saurenmann, MD, head of pediatric department, Department of Rheumatology, University Children's Hospital, and Department of Pediatrics, Kantonsspital Winterthur. traudel.saurenmann@kispi.uzh.ch.
Rotraud K
RK
Saurenmann
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004417:Dyspnea / Q000139:chemically induced; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous / Q000009:adverse effects; D009325:Nausea / Q000139:chemically induced; D012135:Respiratory Sounds; D012189:Retrospective Studies; D014581:Urticaria / Q000139:chemically induced; D014605:Uveitis / Q000188:drug therapy*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab
INFLIXIMAB; INFUSION REACTIONS; JUVENILE IDIOPATHIC ARTHRITIS; UVEITIS