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Low-dose glucocorticoid therapy decreases risk for treatment-limiting infusion reaction to infliximab in patients with rheumatoid arthritis (RA).
  1. Jenny Augustsson (jenny.augustsson{at}apoteket.se)
  1. Dept of Rheumatology, Karolinska University Hospital, Sweden
    1. Staffan Eksborg (staffan.eksborg{at}karolinska.se)
    1. Dept of Woman and Child Health, Karolinska Institute, Sweden
      1. Sofia Ernestam (sofia.ernestam{at}karolinska.se)
      1. Dept of Rheumatology, Karolinska University Hospital, Sweden
        1. Eleanor Gullström (eleanor.gullstrom{at}karolinska.se)
        1. Dept of Rheumatology, Karolinska University Hospital, Sweden
          1. Ronald F van Vollenhoven (ronald.van.vollenhoven{at}ki.se)
          1. Dept of Rheumatology, Karolinska University Hospital, Sweden

            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.

            • DMARD
            • HAQ
            • infliximab
            • oral low-dose glucocorticoids
            • treatment-limiting infusion reaction

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