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Low-dose glucocorticoid therapy decreases risk for treatment-limiting infusion reaction to infliximab in patients with rheumatoid arthritis

Jenny Augustsson^1,2, Staffan Eksborg^2,3, Sofia Ernestam¹, Eleanor Gullström¹, Ronald van Vollenhoven¹

¹ Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
² Karolinska Pharmacy, Karolinska University Hospital Solna, Stockholm, Sweden
³ Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden

Jenny Augustsson, Karolinska Pharmacy, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden; jenny.augustsson{at}apoteket.se

Background and objective: Treatment-limiting infusion reactions to infliximab have not been fully explained in rheumatoid arthritis patients. Our main objective is to investigate the role of daily oral glucocorticoids use on such reactions.

Method: Forty-three patients with immediate-type infusion reactions were identified in a large registry-based cohort. These patients were then compared with the entire cohort (n = 639) and, in a separate analysis, to a nested matched control group (n = 43). The following base-line variables were compared: use of oral glucocorticoids, health-assessment questionnaire, 28-joint count-based disease activity score, duration of disease and number of failed disease-modifying antirheumatic drugs.

Results: The proportion of infusions associated with infusion reactions decreased significantly during the study period (p = 0.0024). Fifty per cent of the patients in the cohort were treated with daily low-dose glucocorticoids at baseline. 15/326 (4.6%) patients had an infusion reaction as compared with 28/324 (8.6%) of patients without glucocorticoid treatment (p = 0.057). In the matched comparison, 15/43 (35%) of the cases were on low-dose glucocorticoids as compared with 27/43 (64%) of the controls (p = 0.017). The use of low-dose glucocorticoids was associated with a significantly lower risk for a treatment-limiting infusion reactions in a Kaplan–Meier analysis (p = 0.04). The number needed to treat to prevent a treatment-limiting infusion reaction was 25 (95% CI: 13 to 527) in the cohort.

Conclusion: The use of daily low-dose glucocorticoids is associated with a lower risk for treatment-limiting infusion reactions to infliximab. Overall, treatment-limiting infusion reactions have become significantly less common during the past 5 years.

Abbreviations: DAS, disease activity score; DMARD, disease-modifying antirheumatic drug; ESR, erythrocyte sedimentation rate; HAQ, health-assessment questionnaire; NNT, number needed to treat; RA, rheumatoid arthritis; TNF, tumour necrosis factor

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