title: Infliximab-Related Infusion Reactions: Systematic Review.
abstract: OBJECTIVE
  Administration of infliximab is associated with a well-recognised risk of infusion reactions. Lack of a mechanism-based rationale for their prevention, and absence of adequate and well-controlled studies, has led to the use of diverse empirical administration protocols. The aim of this study is to perform a systematic review of the evidence behind the strategies for preventing infusion reactions to infliximab, and for controlling the reactions once they occur.
  
  
  METHODS
  We conducted extensive search of electronic databases of MEDLINE [PubMed] for reports that communicate various aspects of infusion reactions to infliximab in IBD patients.
  
  
  RESULTS
  We examined full texts of 105 potentially eligible articles. No randomised controlled trials that pre-defined infusion reaction as a primary outcome were found. Three RCTs evaluated infusion reactions as a secondary outcome; another four RCTs included infusion reactions in the safety evaluation analysis; and 62 additional studies focused on various aspects of mechanism/s, risk, primary and secondary preventive measures, and management algorithms. Seven studies were added by a manual search of reference lists of the relevant articles. A total of 76 original studies were included in quantitative analysis of the existing strategies.
  
  
  CONCLUSIONS
  There is still paucity of systematic and controlled data on the risk, prevention, and management of infusion reactions to infliximab. We present working algorithms based on systematic and extensive review of the available data. More randomised controlled trials are needed in order to investigate the efficacy of the proposed preventive and management algorithms.
authors.affiliation: Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Israel levl@clalit.org.il.
authors.forename: Lev
authors.initials: L
authors.lastname: Lichtenstein
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Israel.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Ron
authors.affiliation: Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Kivity
authors.affiliation: Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Israel.
authors.forename: Shomron
authors.initials: S
authors.lastname: Ben-Horin
authors.affiliation: Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Israeli
authors.affiliation: Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Israel.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fraser
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Dotan
authors.affiliation: Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Chowers
authors.affiliation: Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Confino-Cohen
authors.affiliation: Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Israel.
authors.forename: Batia
authors.initials: B
authors.lastname: Weiss
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab / Q000009:adverse effects* / Q000627:therapeutic use; D007262:Infusions, Intravenous
chemical_list: D000893:Anti-Inflammatory Agents; D000069285:Infliximab
keywords: Crohn’s disease; Infliximab; adverse drug reaction; drug allergy; drug hypersensitivity; drug toxicity; inflammatory bowel disease; infusion reactions; ulcerative colitis