title: Premedication prevents infusion reactions and improves retention rate during infliximab treatment.
abstract: Infliximab (IFX) is an anti-tumor necrosis factor-alpha antibody used to treat inflammatory joint diseases. Infusion reactions (IR) can occur during and after intravenous administration and often require discontinuation of IFX therapy. This retrospective study aimed at evaluating the incidence of IR in patients with joint inflammatory diseases receiving IFX with and without premedication. Clinical charts of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis patients receiving IFX from January 2002 to December 2014 were reviewed. Patients receiving only one premedication protocol over time were enrolled and clustered based on the type of premedication as follows: group 1 received no premedication; group 2 received paracetamol, esomeprazole, hydrocortisone, and chlorpheniramine maleate; group 3 received paracetamol, hydoxyzine, ranitidine, and 6-methylprednisolone. Adverse events were recorded during the infusion, in the following hours and at control visits. The charts of 105 patients treated with IFX were selected. IR were observed in 23/51 patients of group 1, in 7/35 patients of group 2, and none of 19 patients in group 3. IR incidence was significantly lower in the second (p = 0.021) and third (p < 0.001) compared to the first group. The incidence of IR was significantly lower in group 3 than group 2 (p < 0.043). Moreover, patients in group 1 had a relative risk of developing an IR 2.5 times higher than group 2. In our experience, the use of premedication significantly reduced the number of IR to IFX. In particular, the combination of paracetamol, hydroxyzine, 6-methylprednisolone and ranitidine was more efficacious than paracetamol, esomeprazole, hydrocortisone, and chlorpheniramine maleate combination protocol.
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, 50134, Florence, Italy. francesca.bartoli19@gmail.com.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bartoli
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, 50134, Florence, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Bruni
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, 50134, Florence, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cometi
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, 50134, Florence, Italy.
authors.forename: Jelena
authors.initials: J
authors.lastname: Blagojevic
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, 50134, Florence, Italy.
authors.forename: Ginevra
authors.initials: G
authors.lastname: Fiori
authors.affiliation: Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Tofani
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, 50134, Florence, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Galluccio
authors.affiliation: Geffen School of Medicine at the University of California in Los Angeles, Los Angeles, CA, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Furst
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, 50134, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci Cerinic
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002744:Chlorpheniramine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000517:prevention & control*; D064098:Esomeprazole / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D006919:Hydroxyzine / Q000627:therapeutic use; D000069285:Infliximab / Q000009:adverse effects* / Q000627:therapeutic use; D007262:Infusions, Intravenous / Q000009:adverse effects; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011292:Premedication; D011899:Ranitidine / Q000627:therapeutic use; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D006919:Hydroxyzine; D000082:Acetaminophen; D002744:Chlorpheniramine; D011899:Ranitidine; D000069285:Infliximab; D064098:Esomeprazole; D006854:Hydrocortisone; D008775:Methylprednisolone
keywords: Ankylosing spondylitis; Infliximab; Infusion reaction; Premedication; Psoriatic arthritis; Rheumatoid arthritis