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The Use of Infliximab in Academic Rheumatology Practice: an Audit of Early Clinical Experience
MARY-ANN FITZCHARLES, DENISE CLAYTON, and HENRI ANDRÉ MÉNARD
ABSTRACT. Methods. The infusion history of patients referred to the McGill University Health Centre during the first 18 month period of a special access program for treatment with infliximab, a tumor necrosis factor-a antibody, was audited for disease characteristics, dosing schedule for infliximab, concomitant treatments, response rate, and side effect profile. Results. Forty-one patients received a total of 300 infusions of infliximab over a period of 9 ± 5 months (mean ± standard deviation). Rheumatic disease indications were rheumatoid arthritis in 30, spondyloarthropathy in 6, psoriatic arthritis in 2, juvenile onset polyarthritis in 2, and scleroderma in one. Disease duration was 17 ± 11 years. Concomitant treatment with steroids and methotrexate was present in 68% and 54%, respectively. Infliximab treatment was continued beyond 5 infusions or 22 weeks in 63%. Of the 26 patients continuing treatment, adjustment to dosing and/or interval schedule of infusions was made in 58%. The clinical response rate was moderately to greatly improved in 96%. Severe side effects considered directly related to the treatment were observed in 6 (15%) patients; less severe side effects, which did not preclude continuation of treatment but frequently required medical intervention, were noted in 93%. Conclusion. Infliximab is a valuable treatment for patients with resistant rheumatic diseases in the short term. Both the serious, and the frequent, more benign complication rate observed in this group of patients should alert physicians to be vigilant in the routine care of patients treated with infliximab. (J Rheumatol 2002;29:2525-30) Key Indexing Terms:
INFLIXIMAB
From the Division of Rheumatology, McGill University, Montreal, Quebec, Canada. M-A. Fitzcharles, MB, ChB, FRCPC, Associate Professor, Division of Rheumatology and McGill-MGH Pain Centre; D. Clayton, RN, Division of Rheumatology; H-A. Ménard, MD, Professor of Medicine and Director, Division of Rheumatology, McGill University and McGill University Health Centre. Address reprint requests to Dr. M-A. Fitzcharles, McGill University Health Centre at Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4. E-mail: mary-ann.fitzcharles@muhc.mcgill.ca Submitted March 15, 2002, revision accepted June 11, 2002. |