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FOR MORE CORRESPONDENCE SEE BELOW: To the Editor: The recent article about practical experience with infliximab infusion reactions1 was timely and worthwhile. Our experience with just as many patients has been similar. Some differences are worth reporting. At the Arthritis Center of Reno over 100 patients have been given infliximab for a minimum of 3 years for a total of more than 2000 infusions. Ninety-five percent of the infusions have been office-based. Infusions are done over 1 hour unless there is a history of reactions to the infusion. There has been no increase in infusion reactions. At the time of a reaction of significance the infusion is stopped and a second intravenous infusion of saline is initiated. Antihistamine is given only rarely. Intravenous steroids have been given a handful of times for severe periorbital edema, severe urticarial rash, or respiratory distress (the regular use of intravenous steroids confuses the ability to determine if infliximab or steroid is benefiting the patient). Once the reaction resolves, the infusion is restarted at a slower rate and is usually tolerated well. Three patients have developed an acute back pain syndrome characterized by anxiety. This responded well to intravenous antihistamine, but necessitated the discontinuation of infliximab in all 3 patients permanently. Restarting infusions at a much slower rate has made it possible to finish the administration of infliximab after most reactions without further difficulties. Although we are prepared for more serious reactions in the office, infliximab and other biological infusions have been generally well tolerated and accepted by patients in a private rheumatology practice. MALIN PRUPAS, MD, FACP, FACR, Arthritis Center of Reno, 1500 East 2nd Street, Reno, Nevada 89502, USA. REFERENCE 1. Wasserman MJ, Weber DA, Guthrie JA, Bykerk VP, Lee P, Keystone EC. Infusion-related reactions to infliximab in patients with rheumatoid arthritis in a clinical practice setting: relationship to dose, antihistamine pretreatment, and infusion number. J Rheumatol 2004;31:1912-7. |
