title: Factors influencing acute infusion reactions in inflammatory bowel disease patients treated with infliximab in the era of scheduled maintenance therapy.
abstract: BACKGROUND
  An acute infusion reaction during infliximab infusions could lead to drug withdrawal and limit the therapeutic armamentarium in inflammatory bowel diseases.
  
  
  OBJECTIVE
  To determine the risk and protective factors of an acute infusion reaction.
  
  
  METHODS
  Data were retrieved retrospectively from electronic charts of patients from the 'Clermont-Ferrand IBD cohort'.
  
  
  RESULTS
  Among 80 patients, including 51 (63.8%) patients with Crohn's disease, 23 (28.8%) experienced an acute infusion reaction. In multivariate analysis, the Crohn's disease nonstricturing nonfistulizing phenotype predicted an acute infusion reaction (odds ratio=11.40, 95% confidence interval 1.5-87.6; P=0.019).Among 1107 infusions, we observed 38 acute infusion reactions (3.4%). In multivariate analysis, only resumption of infliximab after drug holiday was a major risk factor (odds ratio=24.87, 95% confidence interval 4.4-140.0; P<0.001). Concomitant premedication or immunosuppressant therapies did not prevent an acute infusion reaction.The patients who experienced an acute infusion reaction had a trend toward a higher rate of infliximab discontinuation (69.6 vs. 50.9%, P=0.14).
  
  
  CONCLUSIONS
  An acute infusion reaction is a major event in the history of inflammatory bowel diseases patients treated with infliximab as it could lead to drug discontinuation and thus limits the therapeutic armamentarium considerably. The resumption of infliximab after drug holiday is a major risk factor for an acute infusion reaction. Premedication efficacy remains questionable and should be limited to these high-risk patients.
authors: aDepartment of Gastroenterology, University Hospital Estaing of Clermont-Ferrand bMicrobes, Inflammation, Intestine and Susceptibility of the Host, UMR 1071 INSERM/Auvergne University USC-INRA 2018 cBiostatistics Unit, University Hospital of Clermont-Ferrand, DRCI, Clermont-Ferrand, France.
authors: Cédric
authors: C
authors: Duron
authors: Marion
authors: M
authors: Goutte
authors: Bruno
authors: B
authors: Pereira
authors: Gilles
authors: G
authors: Bommelaer
authors: Anthony
authors: A
authors: Buisson
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D003875:Drug Eruptions / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects*; D007262:Infusions, Intravenous / Q000009:adverse effects; D060046:Maintenance Chemotherapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D006633:Histamine Antagonists; D000069285:Infliximab