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

Jenny Augustsson ^1*, Staffan Eksborg ², Sofia Ernestam ¹, Eleanor Gullström ¹ and Ronald F van Vollenhoven ¹

¹ Dept of Rheumatology, Karolinska University Hospital, Sweden
² Dept of Woman and Child Health, Karolinska Institute, Sweden

^* To whom correspondence should be addressed. E-mail: jenny.augustsson{at}apoteket.se.

Accepted 30 April 2007

Abstract

Background and objective: Treatment-limiting infusion reactions to infliximab have not been fully explained in RA 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 to 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, HAQ, DAS28, duration of disease and number of failed DMARDs.

Results: The proportion of infusions associated with infusion reactions decreased significantly during the study period (p = 0.0024). Fifty percent 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 to 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 to 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 (NNT) to prevent a treatment-limiting infusion reaction was 25 (95% CI: 13-527) 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.

Keywords: DMARD, HAQ, infliximab, oral low-dose glucocorticoids, treatment-limiting infusion reaction

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Furst, D E, Keystone, E C, Kirkham, B, Fleischmann, R, Mease, P, Breedveld, F C, Smolen, J S, Kalden, J R, Burmester, G R, Braun, J, Emery, P, Winthrop, K, Bresnihan, B, De Benedetti, F, Dorner, T, Gibofsky, A, Schiff, M H, Sieper, J, Singer, N, Van Riel, P L C M, Weinblatt, M E, Weisman, M H (2008). Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2008. Ann Rheum Dis 67: iii2-iii25 [Full Text]