Duron Cédric, Goutte Marion, Pereira Bruno, Bommelaer Gilles, Buisson Anthony
aDepartment of Gastroenterology, University Hospital Estaing of Clermont-Ferrand bMicrobes, Inflammation, Intestine and Susceptibility of the Host, UMR 1071 INSERM/Auvergne University USC-INRA 2018 cBiostatistics Unit, University Hospital of Clermont-Ferrand, DRCI, Clermont-Ferrand, France.
Eur J Gastroenterol Hepatol. 2015 Jun;27(6):705-11. doi: 10.1097/MEG.0000000000000354.
An acute infusion reaction during infliximab infusions could lead to drug withdrawal and limit the therapeutic armamentarium in inflammatory bowel diseases.
To determine the risk and protective factors of an acute infusion reaction.
Data were retrieved retrospectively from electronic charts of patients from the 'Clermont-Ferrand IBD cohort'.
Among 80 patients, including 51 (63.8%) patients with Crohn's disease, 23 (28.8%) experienced an acute infusion reaction. In multivariate analysis, the Crohn's disease nonstricturing nonfistulizing phenotype predicted an acute infusion reaction (odds ratio=11.40, 95% confidence interval 1.5-87.6; P=0.019).Among 1107 infusions, we observed 38 acute infusion reactions (3.4%). In multivariate analysis, only resumption of infliximab after drug holiday was a major risk factor (odds ratio=24.87, 95% confidence interval 4.4-140.0; P<0.001). Concomitant premedication or immunosuppressant therapies did not prevent an acute infusion reaction.The patients who experienced an acute infusion reaction had a trend toward a higher rate of infliximab discontinuation (69.6 vs. 50.9%, P=0.14).
An acute infusion reaction is a major event in the history of inflammatory bowel diseases patients treated with infliximab as it could lead to drug discontinuation and thus limits the therapeutic armamentarium considerably. The resumption of infliximab after drug holiday is a major risk factor for an acute infusion reaction. Premedication efficacy remains questionable and should be limited to these high-risk patients.
英夫利昔单抗输注过程中的急性输注反应可能导致停药，并限制炎症性肠病的治疗手段。
确定急性输注反应的风险和保护因素。
回顾性检索“克莱蒙费朗炎症性肠病队列”患者的电子病历数据。
80例患者中，包括51例（63.8%）克罗恩病患者，23例（28.8%）发生急性输注反应。多因素分析显示，克罗恩病非狭窄非瘘管型预测急性输注反应（比值比=11.40，95%置信区间1.5～87.6；P=0.019）。在1107次输注中，观察到38例急性输注反应（3.4%）。多因素分析显示，仅药物假期后恢复使用英夫利昔单抗是主要危险因素（比值比=24.87，95%置信区间4.4～140.0；P<0.001）。联合预处理或免疫抑制治疗不能预防急性输注反应。发生急性输注反应的患者英夫利昔单抗停药率有升高趋势（69.6%对50.9%，P=0.14）。
急性输注反应是接受英夫利昔单抗治疗的炎症性肠病患者病程中的重大事件，因为它可能导致停药，从而极大地限制了治疗手段。药物假期后恢复使用英夫利昔单抗是急性输注反应的主要危险因素。预处理的疗效仍存在疑问，应仅限于这些高危患者。
