Abstract
In the present study we evaluated the impact of baseline antinuclear antibody (ANA) status and use of methotrexate on development of infliximab-related infusion reactions in patients with rheumatoid arthritis (RA) or spondylarthropathies (SpAs), including psoriatic arthritis. All patients with RA (n = 213) or SpA (n = 76) treated with infliximab during the period 1999–2005 at the Department of Rheumatology in Lund, Sweden were included. ANAs were present in 28% and 25% of RA and SpA patients, respectively. Because of differences in baseline characteristics, we used a binary logistic regression model to calculate odds ratios (ORs), adjusting for age, sex and prednisolone dosage. Altogether 21% of patients with RA and 13% of patients with SpA developed infusion reactions (P = 0.126). The OR for development of infusion reactions in RA patients with baseline ANA positivity alone was 2.1. Infliximab without methotrexate and infliximab as monotherapy were associated with ORs of 3.1 and 3.6, respectively. Combining infliximab without methotrexate and ANA positivity yielded an OR for infusion reaction of 4.6. Lower age at disease onset and longer disease duration were associated with infusion reactions (P = 0.012 and P = 0.036, respectively), but age, sex, C-reactive protein, erythrocyte sedimentation rate, Health Assessment Questionnaire and Disease Activity Score-28 at baseline were not. No predictors of infusions reactions were identified in SpA patients. RA patients treated with infliximab without methotrexate, and who are positive at baseline for ANAs are at increased risk for developing infliximab-related infusion reactions.
Highlights
Treatment with infliximab, a chimeric IgG1 antibody that is specific for human tumour necrosis factor-α, has been shown to be effective in treating a variety of inflammatory diseases
In the present study we evaluated the impact of baseline antinuclear antibody (ANA) status and use of methotrexate on development of infliximab-related infusion reactions in patients with rheumatoid arthritis (RA) or spondylarthropathies (SpAs), including psoriatic arthritis
RA patients treated with infliximab without methotrexate, and who are positive at baseline for ANAs are at increased risk for developing infliximab-related infusion reactions
Summary
A chimeric IgG1 antibody that is specific for human tumour necrosis factor-α, has been shown to be effective in treating a variety of inflammatory diseases. Infliximab provides significant and sustained improvement in a majority of patients with rheumatoid arthritis (RA) [1,2] and in spondylarthropathies (SpAs), including psoriatic arthritis [3,4]. One of the clinical problems associated with infliximab treatment is development of infusion reactions. Acute infusion reactions occur within 24 hours and delayed ones develop 2–14 days after initiation of treatment. The great majority of infusion reactions reported during infliximab treatment are characterized by more nonspecific symptoms and are often classified as anaphylactoid ones (i.e. probably nonallergic) [5]. A range of symptoms including headache, nausea, fever or chills, dizziness, flush, pruritus, and chest or back pain have been described in relation to infusions, but these do not necessarily require discontinuation of treatment [1,2,5]
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