Eficacia de la premedicación con un esteroide y un antihistamínico en la prevención de reacciones infusionales por infliximab / Efficacy of premedication with intravenous corticosteroids and antihistaminics in preventing infusion reactions to infliximab

OBJETIVO: La administración de infliximab puede provocarla aparición de reacciones infusionales (RI) agudas o retardadas que pueden ser causa de la suspensión del tratamiento. Nuestro objetivo fue conocer la frecuencia de aparición de RI en pacientes con una enfermedad inflamatoria intestinal que han recibido tratamiento con infliximab, utilizando un protocolo de premedicación con un esteroide y un antihistamínico.MÉTODOS: Estudio prospectivo en 100 pacientes consecutivos (74 con enfermedad de Crohn y 26 con colitis ulcerosa) tratados con infliximab en pauta de inducción (3 dosis: semanas 0, 2 y 6), seguida o no de terapia de mantenimiento cada 8 semanas. Se administraron por vía intravenosa, de forma sistemática 30 min antes de cada infusión, 100 mg dehidrocortisona y 5 mg de dexclorfeniramina.RESULTADOS: La media de edad de los pacientes era de 40,9± 13 años; un 51% eran mujeres y un 38%, fumadores. El92% de los pacientes recibía tratamiento inmunomoduladorde base con azatioprina/mercaptopurina (85%) o metotrexato (7%). El número total de infusiones fue de 560 (media de 5,6 por paciente; rango, 1-21). El 56% de los pacientes siguió un tratamiento de mantenimiento. La media de seguimiento fue de 17 ± 16 meses. Se produjeron RI en el 6% de los pacientes y en el 1,4% de todas las infusiones (8/560). Todas las RI fueron leves o moderadas. Cinco pacientes presentaron RI inmediatas tras la segunda dosis. Una paciente presentó una RI retardada en forma de exantema a los 5 días de la segunda infusión. El tratamiento con infliximabse suspendió únicamente en 3 casos: el paciente que presentó la RI retardada y 2 de los pacientes con RI inmediatas que reaparecieron durante la tercera infusión.CONCLUSIÓN: En los pacientes con una enfermedad inflamatoria intestinal, bajo profilaxis con inmunomoduladores, la premedicación con un esteroide y un antihistamínico se asocia a una baja tasa de RI por infliximab. El tratamiento con infliximab sólo se suspendió en el 3% de los casos tras un estrechoseguimiento

AIM: Infliximab can provoke acute or delayed infusion reactions (IR) leading to treatment withdrawal. Our aim was to determine the frequency of IR in patients with inflammatory bowel disease receiving intravenous infliximab and premedicated with steroids and antihistaminics.METHODS: We prospectively studied 100 consecutive patients (74 with Crohn’s disease, 26 with ulcerative colitis) treated with infliximab induction therapy (3 doses: weeks 0- 2-6), followed or not by maintenance every 8 weeks. All patients were premedicated with 100 mg i.v. hydrocortisone and 5 mg i.v. dexchlorpheniramine 30 min before each infusion.RESULTS: The mean age was 40.9 ± 13 years (51% females,and 38% smokers). Ninety-two percent of the patients wereunder immunomodulator therapy(azathioprine/mercaptopurine85% or methotrexate 7%). A total of 560 infusionswere administered, with a mean of 5.6 per patient (range, 1- 21). Fifty-six percent of the patients received maintenance therapy. The mean length of follow-up was 17 ± 16 months. IR occurred in 6 patients (6%) and in 1.4% of all infusions (8/560). All reactions were mild or moderate. Five IR were immediate, occurring in the second infusion. One IR was delayed (exanthema 5 days after the second infusion). Infliximab therapy was discontinued in only 3 patients (in the patientwith the delayed IR and in 2 patients with immediateIR that reappeared during the third infusion).CONCLUSION: In patients with inflammatory bowel diseasetreated with infliximab and under immunomodulator therapy, premedication with steroids and antihistaminics was associated with a low prevalence of IR. Moreover, after close follow-up, infliximab had to be discontinued in only 3% of the patients

[Efficacy of premedication with intravenous corticosteroids and antihistaminics in preventing infusion reactions to infliximab]. / Eficacia de la premedicación con un esteroide y un antihistamínico en la prevención de reacciones infusionales por infliximab.

AIM: Infliximab can provoke acute or delayed infusion reactions (IR) leading to treatment withdrawal. Our aim was to determine the frequency of IR in patients with inflammatory bowel disease receiving intravenous infliximab and premedicated with steroids and antihistaminics. METHODS: We prospectively studied 100 consecutive patients (74 with Crohn's disease, 26 with ulcerative colitis) treated with infliximab induction therapy (3 doses: weeks 0-2-6), followed or not by maintenance every 8 weeks. All patients were premedicated with 100 mg i.v. hydrocortisone and 5 mg i.v. dexchlorpheniramine 30 min before each infusion. RESULTS: The mean age was 40.9+/-13 years (51% females, and 38% smokers). Ninety-two percent of the patients were under immunomodulator therapy (azathioprine/ mercaptopurine 85% or methotrexate 7%). A total of 560 infusions were administered, with a mean of 5.6 per patient (range, 1-21). Fifty-six percent of the patients received maintenance therapy. The mean length of follow-up was 17+/-16 months. IR occurred in 6 patients (6%) and in 1.4% of all infusions (8/560). All reactions were mild or moderate. Five IR were immediate, occurring in the second infusion. One IR was delayed (exanthema 5 days after the second infusion). Infliximab therapy was discontinued in only 3 patients (in the patient with the delayed IR and in 2 patients with immediate IR that reappeared during the third infusion). CONCLUSION: In patients with inflammatory bowel disease treated with infliximab and under immunomodulator therapy, premedication with steroids and antihistaminics was associated with a low prevalence of IR. Moreover, after close follow-up, infliximab had to be discontinued in only 3% of the patients.