GOTHENBURG, SWEDEN – More than one-fifth of infliximab patients who had a temporary medical situation contraindicating administration of the biologic presented for their scheduled infusion unaware treatment would be inappropriate at that time.
The finding from the RemiTRAC Infusion Registry – a large, prospective, observational Canadian registry of patients on infliximab for any indication – underscores the importance of reviewing the full list of contraindications to infliximab with every patient prior to each infusion, said Dr. Warren J. Winkelman said at the annual congress of the European Academy of Dermatology and Venereology. This is the key to minimizing infusion reactions.
The most common medical conditions RemiTRAC participants mistakenly perceived as not being a problem were flulike symptoms and upper respiratory infections, despite the fact patients were informed that these symptoms increased the risk of adverse events as part of standard pretreatment education.
The lesson provided by RemiTRAC is that it is particularly important to inquire about flulike symptoms and colds before administering an infliximab infusion, according to Dr. Winkelman of the University of Toronto.
He reported on 718 patients on infliximab for any indication at more than a dozen Canadian sites participating in the RemiTRAC Infusion Registry. The indication for the antitumor necrosis factor (TNF)–alpha agent was rheumatoid arthritis in 51% of patients, ankylosing spondylitis in 17%, Crohn’s disease in 11%, psoriasis in 9%, psoriatic arthritis in 6%, and ulcerative colitis in 4%.
Participants in the registry received a mean of 15 infliximab infusions during more than 900 patient-years of exposure to the biologic agent. Of 8,051 scheduled infusions, 6% were not administered because of clinical reasons. Sixty-two percent of these cancelled infusions were scotched because of infections, mainly upper respiratory infections or flulike symptoms. Another 9% of cancelled treatments were the result of scheduled surgery.
In 22% of instances of cancelled infusion, patients came to the clinic for their infusion unaware that their health status at that particular time was inappropriate for administration of anti-TNF therapy, according to Dr. Winkelman.
The overall incidence of infusion reactions was 2.1%. The rate was 2.6% in patients being treated for rheumatoid arthritis, 1.9% in those with psoriasis, 0.7% in those with psoriatic arthritis, and 1.3% in patients with ankylosing spondylitis.
The RemiTRAC Infusion Registry was supported by Schering-Plough Canada, which is now part of Merck. Dr. Winkelman disclosed serving as a consultant to the company.