炎症性肠病患儿快速 infliximab 输注：一项多中心北美经验。
Rapid Infliximab Infusion in Children with Inflammatory Bowel Disease: A Multicenter North American Experience.
机构信息
*Section of Pediatric Gastroenterology, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada;†Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada;‡Department of Pediatrics, University of Alexandria, Alexandria, Egypt;§Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio;‖Pediatric Gastroenterology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin;¶Department of Pediatrics, University of Alberta, Edmonton, AB, Canada;**Pediatric Gastroenterology, Dell Children's Medical Center of Central Texas, Austin, Texas;††Department of Pediatrics, University of Calgary, Calgary, AB, Canada;‡‡Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri;§§Pediatric Gastroenterology, Nicklaus Children's Hospital, Miami, Florida;‖‖Pediatric Gastroenterology, Stanford Children's Health, John Muir Hospital, Walnut Creek, California; and¶¶Division of GI, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Inflamm Bowel Dis. 2017 Dec;23(12):2104-2108. doi: 10.1097/MIB.0000000000001259.
BACKGROUND
Infliximab (IFX) infusion may lead to development of anti-IFX antibodies, and subsequent infusion reactions (IRs). The safety of rapid IFX infusion administered over 60 minutes has been under-investigated in children with inflammatory bowel disease. In a multicenter study, the frequency and nature of rapid infusion-associated IRs were examined.
METHODS
The medical records of all consecutive children with inflammatory bowel disease receiving rapid IFX infusions between January 2014 and December 2016 were reviewed. Poisson regression analysis was used to identify possible associated factors with IRs.
RESULTS
A total of 4120 rapid infusions for 453 children (median age 16 yrs [interquartile range 13.8-17.8], 289 males, 374 with Crohn's disease) were included. One hundred thirty-five participants (29.8%) received rapid IFX infusion for induction and maintenance while the rest received rapid IFX infusion after a median of 5 (interquartile range 4-9) standard infusions. The median dose of IFX using rapid protocol was 8 mg/kg/infusion (interquartile range 6-10). Two hundred sixty-seven (59%) patients received 1 or more premedications and 161 (35.5%) participants received concomitant immunosuppression. Twenty-one participants (4.6%) had IRs with rapid infusions and 2 participants discontinued IFX because of IRs (0.4%). Antihistamine premedications were associated with less frequent IR (adjusted relative risk = 0.30; 95% confidence interval, 0.14-0.64; P = 0.002).
CONCLUSIONS
In children with inflammatory bowel disease, rapid IFX infusion administered over 60 minutes is safe and well-tolerated. Antihistamine premedications may reduce frequency of IRs (see Video Abstract, Supplemental Digital Content 1, http://links.lww.com/IBD/B632).
背景
英夫利昔单抗（IFX）输注可能导致抗 IFX 抗体的产生，并随后引发输注反应（IRs）。在炎症性肠病儿童中，快速 IFX 输注超过 60 分钟的安全性尚未得到充分研究。在一项多中心研究中，检查了快速输注相关 IRs 的频率和性质。
方法
回顾了 2014 年 1 月至 2016 年 12 月期间连续接受快速 IFX 输注的所有炎症性肠病儿童的病历。采用泊松回归分析确定与 IRs 相关的可能因素。
结果
共纳入 453 名儿童的 4120 次快速输注（中位年龄 16 岁[四分位距 13.8-17.8]，289 名男性，374 名克罗恩病）。135 名参与者（29.8%）接受快速 IFX 输注进行诱导和维持，其余参与者在接受中位数为 5（四分位距 4-9）次标准输注后接受快速 IFX 输注。快速方案使用的 IFX 中位数剂量为 8mg/kg/输注（四分位距 6-10）。267（59%）名患者接受了 1 种或多种预处理药物，161（35.5%）名参与者接受了同时免疫抑制治疗。21 名参与者（4.6%）在快速输注时有 IRs，2 名参与者因 IRs 而停止使用 IFX（0.4%）。抗组胺药物预处理与较少发生 IR 相关（调整后的相对风险=0.30；95%置信区间，0.14-0.64；P=0.002）。
结论
在炎症性肠病儿童中，超过 60 分钟的快速 IFX 输注是安全且耐受良好的。抗组胺药物预处理可能会降低 IRs 的频率（见视频摘要，补充数字内容 1，http://links.lww.com/IBD/B632）。
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