Gastroenterology, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France, France.
Gastroenterology, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France, France.
Dig Liver Dis. 2019 Apr;51(4):484-488. doi: 10.1016/j.dld.2018.12.002. Epub 2018 Dec 13.
Up to 25% of patients treated with infliximab experience hypersensitivity reactions. Prophylactic premedication prior to infliximab infusion, comprising corticosteroids and/or antihistamines, is widely used in clinical practice but its efficacy has recently been called into question due to the lack of pathophysiological rationale and validation by controlled trials.
We conducted a comprehensive literature search of multiple electronic databases from inception to June 2017 to identify studies reporting the impact of corticosteroid and/or antihistamine premedication on the risk of acute (<24 h) hypersensitivity reaction to infliximab in immune-mediated inflammatory diseases (IMIDs). Random-effects meta-analysis was performed.
Ten studies, eight observational studies and two randomized control trials, were identified including a total of 3892 patients with IMIDs, and 1,385 patients with IBD. Corticosteroid premedication was not associated with a decreased risk of hypersensitivity reaction in either IMIDs (7 studies; OR, 1.07, 95%CI, 0.64-1.78; I = 57.5%) or IBD (3 studies; OR, 1.04, 95% CI, 0.52-2.07; I = 57%). Antihistamine premedication was not associated with a decreased risk of hypersensitivity reaction in IMIDs (3 studies: OR, 1.39, 95% CI, 0.70-2.73; I = 85%). The combination of corticosteroids and antihistamines did not decrease the risk of acute infliximab infusion reaction in IMIDs (6 studies; OR, 2.12, 95% CI, 0.61-7.35; I = 94%), but was associated with an increased risk in IBD (4 studies, OR, 4.17, 95% CI, 1.61-10.78; I = 77%).
Corticosteroid and/or antihistamine premedication is not associated with a decreased risk of acute hypersensitivity reactions to infliximab in patients with IMIDs. We believe that these premedications should no longer be part of standard protocols.
多达 25%接受英夫利昔单抗治疗的患者会出现过敏反应。在英夫利昔单抗输注前预防性使用皮质类固醇和/或抗组胺药，在临床实践中被广泛应用，但由于缺乏病理生理学依据，且对照试验未能证实其疗效，最近其应用受到质疑。
我们对从创建至 2017 年 6 月的多个电子数据库进行了全面文献检索，以确定报告皮质类固醇和/或抗组胺药预处理对免疫介导的炎症性疾病（IMIDs）患者英夫利昔单抗急性（<24 小时）过敏反应风险影响的研究。采用随机效应荟萃分析。
共纳入 10 项研究，其中 8 项为观察性研究，2 项为随机对照试验，共纳入 3892 例 IMIDs 患者和 1385 例 IBD 患者。皮质类固醇预处理与 IMIDs（7 项研究；OR，1.07，95%CI，0.64-1.78；I²=57.5%）或 IBD（3 项研究；OR，1.04，95%CI，0.52-2.07；I²=57.5%）患者的过敏反应风险降低无关。抗组胺药预处理与 IMIDs（3 项研究：OR，1.39，95%CI，0.70-2.73；I²=85%）患者的过敏反应风险降低无关。皮质类固醇和抗组胺药联合应用并未降低 IMIDs 患者急性英夫利昔单抗输注反应的风险（6 项研究；OR，2.12，95%CI，0.61-7.35；I²=94%），但与 IBD 患者（4 项研究，OR，4.17，95%CI，1.61-10.78；I²=77%）的风险增加相关。
皮质类固醇和/或抗组胺药预处理与 IMIDs 患者急性英夫利昔单抗过敏反应风险降低无关。我们认为，这些预处理措施不应再作为标准方案的一部分。
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