St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, U.K.
Br J Dermatol. 2012 Aug;167(2):411-6. doi: 10.1111/j.1365-2133.2012.10931.x. Epub 2012 Jun 11.
Infliximab is an antitumour necrosis factor-α chimeric monoclonal antibody that is an established treatment for severe chronic plaque psoriasis. The recommended administration of a 2-h infusion followed by 2 h of monitoring is practised due to the potential occurrence of infusion reactions. However, accelerated infusions and shortened monitoring periods are used in patients with rheumatological disorders and inflammatory bowel disease without an increase in adverse events.
To review the standard infliximab infusion protocol, the incidence of acute infusion reactions, the use of concomitant methotrexate and the clinical relevance of the 2-h postinfusion monitoring period.
A retrospective case note and pharmacy database review of all infliximab infusions administered to patients with psoriasis at a tertiary dermatology centre was carried out.
Fifty-nine consecutive patients received a total of 858 infliximab infusions (range 1-43 infusions per patient) between January 2001 and June 2010. The incidence of infusion reactions was 1.5%, affecting 16.9% of patients and occurring between the first and eleventh infusions. Mild, moderate and severe acute reactions occurred in 0.6% (n=5), 0.3% (n=3) and 0.3% (n=3) of infliximab infusions, respectively. Thirty-three patients (56%) received concomitant systemic treatments during part of or throughout the infliximab treatment, including 24 (41%) on methotrexate (5-20 mg weekly). The prevalence of infusion reactions in patients receiving infliximab alone was 27% compared with 4% in those receiving concomitant methotrexate (P=0.05). All infusion reactions were managed as per our trust protocol with only one infusion reaction occurring in the postinfusion period (10 min after infusion completion).
The risk of infusion reactions in our cohort of patients was low, with the majority occurring early in the treatment cycle. Concomitant methotrexate may reduce this risk. A shortened postinfusion monitoring period can be safely considered.
英夫利昔单抗是一种抗肿瘤坏死因子-α嵌合单克隆抗体，已被确立为治疗严重慢性斑块型银屑病的方法。由于可能发生输注反应，建议进行 2 小时输注，随后进行 2 小时监测。然而，在患有风湿性疾病和炎症性肠病的患者中，输注速度加快，监测时间缩短，而不会增加不良事件。
回顾英夫利昔单抗输注标准方案、急性输注反应发生率、同时使用甲氨蝶呤以及 2 小时输注后监测期的临床相关性。
对 2001 年 1 月至 2010 年 6 月期间在一家三级皮肤科中心接受英夫利昔单抗治疗的所有银屑病患者的病历和药房数据库进行回顾性病例分析。
59 例连续患者共接受了 858 次英夫利昔单抗输注（每位患者的输注次数为 1-43 次）。输注反应的发生率为 1.5%，影响了 16.9%的患者，发生在第一次至第十一次输注之间。轻度、中度和重度急性反应分别发生在 0.6%（n=5）、0.3%（n=3）和 0.3%（n=3）的英夫利昔单抗输注中。33 例（56%）患者在部分或整个英夫利昔单抗治疗期间接受了联合全身治疗，其中 24 例（41%）接受了甲氨蝶呤（5-20mg/周）。单独接受英夫利昔单抗治疗的患者中输注反应的发生率为 27%，而同时接受甲氨蝶呤治疗的患者中输注反应的发生率为 4%（P=0.05）。所有输注反应均根据我们的信托方案进行管理，仅在输注后期间（输注完成后 10 分钟）发生了一次输注反应。
在我们的患者队列中，输注反应的风险较低，大多数反应发生在治疗周期的早期。同时使用甲氨蝶呤可能会降低这种风险。可以安全地考虑缩短输注后监测期。
