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Inicio Gastroenterología y Hepatología (English Edition) Infliximab in inflammatory bowel disease. Is premedication necessary?
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Vol. 44. Issue 5.
Pages 321-329 (May 2021)
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Vol. 44. Issue 5.
Pages 321-329 (May 2021)
Original article
DOI: 10.1016/j.gastre.2020.07.012
Infliximab in inflammatory bowel disease. Is premedication necessary?
Infliximab en enfermedad inflamatoria intestinal. ¿Es necesario premedicar?
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Paulina Nuñez F.a, Rodrigo Querab,
Corresponding author
rquera@clc.cl

Corresponding author.
, Daniela Simianb, Lilian Floresa, Carolina Figueroaa, Patricio Ibañeza, Udo Kronbergc, Jaime Lubaschera, Gonzalo Pizarroa
a Programa Enfermedad Inflamatoria Intestinal, Departamento Gastroenterología, Hospital San Juan de Dios Hospital, Universidad de Chile, Santiago, Chile
b Clínica Las Condes, Santiago, Chile
c Unidad de Coloproctología, Departamento de Cirugía, Clínica Las Condes, Santiago, Chile
Article information
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Figures (2)
Tables (4)
Table 1. Clinical and demographic characteristics of patients with infliximab.
Table 2. Infliximab infusion characteristics.
Table 3. Acute post-infusion reactions.
Table 4. Acute infusion reactions.
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Abstract
Background

The use of infliximab (IFX) in inflammatory bowel disease (IBD) has been associated with a 1–6% risk of infusion reactions. The usefulness of premedication with corticosteroids, paracetamol and /or antihistamines is controversial.

Aim

The aim of this study is to assess, in IBD patients on IFX, whether there are differences in secondary reactions to the infusion between those who use premedication or not.

Methods

A retrospective cohort study was performed identifying patients with a diagnosis of IBD who received IFX at our institution between January 2009 and July 2019. Acute reactions were defined as those that occurred in the first 24h post infusion and late reactions for more than 24h. Infusion reactions were classified as mild, moderate and severe. Descriptive and association statistics were used (χ2; p<0.05).

Results

Sixty-four patients were included with 1,263 infusions in total, 52% men. Median infusions per patient was 22 (2–66). All induction infusions were administered with premedication, and in maintenance in 57% of them. Premedication was given with hydrocortisone, chlorphenamine and paracetamol. Most of reactions were acute, mild or moderate in severity and no patient needed to discontinue IFX. In the maintenance group, there were 9/718 (1.2%) infusion reactions with premedication and 4/358 (1.1%) without it (p=0.606). In the induction group, there were 8/187 (4.3%) infusion reactions, significantly higher when compared with both maintenance groups.

Conclusions

In this group, premedication use during maintenance was not effective at reducing the rate of infusion reactions. These results suggest that premedication would not be necessary.

Keywords:
Infliximab
Adverse reactions
Inflammatory bowel disease
Crohn’s disease
Ulcerative colitis
Resumen
Introducción

El uso de infliximab (IFX) en enfermedad inflamatoria intestinal (EII) se ha asociado con un riesgo de 1–6% de reacciones a la infusión. La utilidad de premedicación con corticoides, paracetamol y/o antihistamínicos es controvertido.

Objetivo

Evaluar si en pacientes con EII que utilizan IFX hay diferencias en las reacciones secundarias a infusión entre aquellos que utilizan o no premedicación.

Métodos

Estudio descriptivo, observacional, retrospectivo en pacientes con EII, que han utilizado IFX entre enero 2009 y julio 2019. Se definieron como reacciones agudas aquellas ocurridas en las primeras 24hrs.post infusión y tardías después de ese período, clasificándose en leves, moderadas y severas. Se usó estadística descriptiva y de asociación (χ 2; p<0,05).

Resultados

Se incluyeron 1,263 infusiones en un total de 64 pacientes, 52% hombres. Mediana de infusiones por paciente 22 (2–66). El 100% de las infusiones en inducción fueron con premedicación y en mantenimiento el 57%. La premedicación fue realizada con hidrocortisona, clorfenamina y paracetamol. La mayoría de las reacciones fueron agudas, de gravedad leve a moderada y ningún paciente necesitó descontinuar IFX. En mantenimiento hubo 9/718 (1.2%) reacciones a la infusión con premedicación y 4/358 (1.1%) sin ésta, sin diferencias significativas (p=0.606). En inducción hubo 8/187(4.3%) reacciones a la infusión, significativamente mayor al compararlas con ambos grupos de mantenimiento.

Conclusión

En esta cohorte de pacientes, el no usar premedicación en fase de mantenimiento de IFX no aumentó el número de eventos adversos a este fármaco. Estos resultados sugieren que su indicación no sería necesaria.

Palabras clave:
Infliximab
Reacciones adversas
Enfermedad inflamatoria intestinal
Enfermedad de Crohn
Colitis ulcerosa

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