 |
|
|
 |
To the Editor: The experience reported by Dr. Prupas is of considerable interest. With regard to the duration of infliximab infusion, we are interested to learn of his experience with a shortened duration of infusion. His experience is consistent with recent data from a Centocor-sponsored study. With regard to the use of antihistamines, our experience as described1 suggests that antihistamines may not be helpful, particularly as a pretreatment regimen. We still use antihistamines for more serious reactions of the kind described by Dr. Prupas. We have also had experience with patients developing severe back pain. These symptoms have subsided spontaneously with discontinuation of the infusion. Whether intravenous antihistamines would shorten the course of the symptom requires further study. Finally, we certainly concur with Dr. Prupas that restarting infusions at a much slower rate has made it possible to finish infliximab administration in most, but not all patients. We also agree that despite the frequent minor side effects during infusions of infliximab, few patients permanently withdraw therapy on this account. Infliximab is well tolerated and accepted by patients in an academic rheumatology center. EDWARD C. KEYSTONE, MD, FRCPC, Professor of Medicine, University of Toronto, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Josef and Wolf Lebovic Building, Mount Sinai Hospital, 60 Murray Street, 2nd Floor, Toronto, Ontario M5T 3L9. E-mail: edkeystone@mtsinai.on.ca 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. |
