Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Reduced Incidence of Infusion Reactions to Infliximab in Patients Pre-Medicated with Acetaminophen
Choquette1, D., Bensen2, William G., Nantel3, Francois
Patients treated with infliximab (IFX) sometimes receive premedication in order to reduce the risk of infusion reactions (IR). These pre-medications including anti-histamines, intravenous steroids or acetaminophen either alone or in combination, are sometimes used by physicians in order to prevent the development of allergic reactions.
RemiTRAC Infusion is an observational registry among 12 Canadian sites where patients receiving IFX are followed prospectively to document pre-medication use, adverse events, infusion reactions and the management of IRs. Seven hundred and fourteen subjects have been enrolled since the registry inception in 2005. A total of 7598 infusions were recorded with a mean of 10.6 ± 7.3 infusions per patient representing 935 years of exposure. The majority of patients (n=366 or 51%) had rheumatoid arthritis whereas 17% (n=120) had ankylosing spondylitis and 6% (n=42) had psoriatic arthritis. The remaining patients were treated for gastroenterological or dermatological diseases.
Among all infusions recorded (n=7598), 161 infusions resulted in an IR (2.1%) and almost all IRs were mild to moderate in severity (151/161 or 94%). Anti-histamines were used in 1591 infusions (21%) compared to steroids and acetaminophen which were used in 1488 (20%) and 1694 (22%) of infusions, respectively. The table below shows the effect of pre-medication on the incidence of IRs.
|Premedication||Number of IRs (IR/# of infusions)||Incidence of IRs (%)||p value (vs None group)|
|AH + Ster||24/292||8.2%||<0.0001|
|Ster + Acet||1/211||0.5%||<0.05|
|AH + Acet||4/337||1.2%||n.s.|
|AH + Ster + Acet||5/416||1.2%||n.s.|
There was a significantly higher incidence of IRs in infusions that were pre-medicated compared to infusions that had no pre-medication (2.4 % vs 1.9%, p<0.05). Most of this increase could be accounted to anti-histamine pre-medication, either alone or in combination with steroids. This elevation in IRs under anti-histamine or steroid pre-medication may result from a selection bias since patients who experienced an IR were more likely to receive pre-medication and to have a subsequent IR. Surprisingly though, infusions in patients receiving acetaminophen, either alone or in combination with steroids, had a significantly reduced incidence of IR.
In a "real-life setting" registry, acetaminophen appears to be a premedication that significantly reduces the incidence of infusion reactions to IFX. The mechanism is unknown but suggests that most infusion reactions might be non-immunogenic in nature.
To cite this abstract, please use the following information:
Choquette, D., Bensen, William G., Nantel, Francois; Reduced Incidence of Infusion Reactions to Infliximab in Patients Pre-Medicated with Acetaminophen [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1662