Abstract
The incidence of anaphylactic reaction after the long-term use of abatacept has not been reported until now. Herein, we present a case of rheumatoid arthritis (RA) in which the patient experienced an anaphylactic reaction one year after initiation of treatment with abatacept. A 75-year-old woman visited our hospital with symptoms of bilateral knee pain and swelling. She was initially treated with methotrexate (6 mg/week increased to 8 mg/week). Two months later, because of inadequate response, self-injections of abatacept (subcutaneous; 125 mg every two weeks) were prescribed. However, 6 months later, because of frequent stomatitis, the methotrexate dose was decreased to 6 mg/week, which resulted in worsening of RA. We changed the route of abatacept administration from subcutaneous injection to intravenous infusion (500 mg/month as a drip). After 30 min of starting the drip, the patient experienced itchiness and drop in vital signs, which were managed using methylprednisolone (2 doses, 125 mg each), dopamine hydrochloride (8 mg/h), and oxygen therapy (flow decreased from 3 L/min to 1 L/min). Wheals and redness were treated with oral antihistamines. Six hours after the onset of the anaphylactic reaction, the vital signs were stabilized. On the subsequent day, the patient’s general state was confirmed to be normal. One month later, etanercept (25 mg) treatment was initiated. The patient is currently in remission. We recommend caution when changing the route of administration and dosage of abatacept in anti-cyclic citrullinated peptide antibody-positive patients or those with a history of mild infusion-related reaction.
Highlights
IntroductionAnd appropriate intervention with conventional systemic disease-modifying antirheumatic drugs (csDMARDs), such as methotrexate (MTX) and biological DMARDs (bDMARDs), has made clinical, structural, and functional remission of rheumatoid arthritis (RA) possible [1]
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease
We recommend caution when changing the route of administration and dosage of abatacept in anti-cyclic citrullinated peptide antibody-positive patients or those with a history of mild infusion-related reaction
Summary
And appropriate intervention with conventional systemic disease-modifying antirheumatic drugs (csDMARDs), such as methotrexate (MTX) and biological DMARDs (bDMARDs), has made clinical, structural, and functional remission of RA possible [1]. Respiratory complications, such as pneumonitis and tuberculosis are associated with the use of bDMARDs. In particular, the incidence of bDMARD-related respiratory complications is higher in patients aged ≥ 65 years [2]. Anaphylactic shocks occurred in 0.12% patients who received abatacept, as an infusion-related reaction [3]; there have been no reports on the incidence of anaphylactic reaction as an adverse reaction to the long-term (one or more years) use of abatacept. We report the case of anaphylactic reaction that occurred after switching from the subcutaneous (injection form) to intravenous route (infusion form) of administration
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