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

Montreal, QC,
McMaster University, Hamilton, ON,
Kirkland, QC, QC

Purpose:

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.

Methods:

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.

Results:

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.

PremedicationNumber of IRs (IR/# of infusions)Incidence of IRs (%)p value (vs None group)
None87/45321.9 %
Any74/30662.4%<0.05
Anti-histamines (AH)57/15913.6%<0.0001
Steroids (Ster)45/14883.0%<0.001
Acetaminophen (Acet)17/16941.0%<0.0001
AH alone19/4684.0%<0.01
Ster alone10/5032.0%n.s.
Acet alone4/6760.6%<0.0001
AH + Ster24/2928.2%<0.0001
Ster + Acet1/2110.5%<0.05
AH + Acet4/3371.2%n.s.
AH + Ster + Acet5/4161.2%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.

Conclusion:

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
DOI: 10.1002/art.26736

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