P232. Shorter infliximab administration infusion times in Crohn's disease are safe and well tolerated
S. Peake1, J. Landy1, C. Tee2, T. Tyrrell3, M. O'Connor4, H. Middleton5, D. Bernardo2, A. Hart4
1St Mark's Hospital, London, United Kingdom; 2Antigen Presentation Research Group, Imperial College, London, United Kingdom; 3St Mark's Hospital, IBD, London, United Kingdom; 4St Mark's Hospital, Gastroenterology, London, United Kingdom; 5St Marks Hospital, IBD Unit, London, United Kingdom
Background: Infliximab (IFX, a mouse-human chimeric monoclonal antibody TNF-alpha) is an effective treatment for Crohn's disease (CD). Generally it is administered as a 5 mg/kg dose and infused over 2 hours. Infusion reactions occur in 923%. A study in 2006 in rheumatology patients demonstrated no increase in adverse events (including infusion reactions) when using an accelerated IFX infusion protocol (first four infusions over 2hrs, next five over 1 hour and subsequent infusions over 30min). In recent years, shorter IFX infusion times (1 hour) have been used for IBD patients already established on 2 hourly infusion schedules with no adverse outcome. Since 2006, the St Mark's Hospital IBD Day Unit administers the first 2 IFX infusions over 2 hours (with 2hr observation period), next 10 over 1hr (1hr observation period) and all subsequent infusions over 30mins (followed by 30min observation period). We set out to determine the safety and tolerability of this IFX regime in patients with CD.
Methods: A retrospective analysis was performed of all IFX infusions administered to CD patients on the IBD Day Unit from the initiation of the new infusion policy (May 2006) to July 2011. The clinical notes for patients who experienced an adverse reaction were retrieved and information obtained on the IFX infusion parameters and nature of reaction. Fisher's exact test was performed for statistical analysis.
Results: Over the 62-month study period, 2789 IFX infusions were administered to patients with CD on the IBD Day Unit (increasing from a mean of 22.4 infusions/month in 2006 to 108.3 in 2010/11). Of these, 485 infusions were given over 30 minutes (17.4% of all infusions). 162 adverse reactions occurred (5.8%), with 31 (1.1%) being severe (1 anaphylaxis, 30 anaphylactoid reactions). Only 2 reactions occurred in patients receiving 30min infusions (0.41%). The reactions were mild (nausea). Statistically fewer infusion reactions occurred in the 30min group (p < 0.001) compared to the 12hr-infusion group. In both cases, subsequent infusions were given over 1hr with no adverse events. One patient was re-tried on 30min infusions after 12 months with no further episodes of intolerance.
Conclusions: Shortened IFX infusion times appears safe and well tolerated in CD patients already established on infliximab therapy. Shortening the IFX infusion time reduces patient's length of stay on the Day Unit and allows for more treatments to be administered per session, resulting in overall improvement in the service to patients.