Steenholdt C, Svenson M, Bendtzen K et al. Aliment Pharmacol Ther 2011;34:51–8.
The incidence of acute severe reactions to infliximab in IBD patients was determined in this investigation. The role of anti-infliximab antibodies and other potential risk factors (e.g. age, episodic vs. continuous treatment) for acute severe reactions were investigated. Such reactions were strongly associated with the development of anti-infliximab immunoglobulin G antibodies, and the risk was particularly high with the second infusion in a retreatment series.
Infliximab elicits acute severe infusion reactions in approximately 5% of patients with IBD. In this study from a university hospital in Denmark, the investigators explored the incidence of acute severe reactions to infliximab between 1999 and 2010 in IBD patients, and the role of anti-infliximab antibodies and other risk factors in these reactions. Acute severe reactions were defined as occurring during the infliximab infusion and judged as severe by the treating physician, resulting in immediate and permanent discontinuation of infliximab and symptomatic treatment with antihistamines and steroids. Infliximab was infused either continuously (every 4–12 weeks) or episodically (reinitiation after >12 weeks). Anti-infliximab antibodies (both immunoglobulin G [IgG] and IgE) were measured using radioimmunoassay. The radioimmunoassay used was not influenced by the potential artifacts encountered with solid-phase enzyme-immunoassays and could detect all isotypes of Igs and all IgG subclasses binding to infliximab with little interference from infliximab itself.