PWE-070 Post biological infusion monitoring; is it really necessary?

Abstract

Listen

Translate article

Introduction Biologic infusion services are seeing ever increasing activity. Facilitating this in a timely and safe manner with limited capacity is increasingly difficult. Patients are monitored for infusion reactions following infliximab (IFX) and vedolizumab (VDZ) infusions, based on recommendations from the product manufacturers. Patients receiving IFX infusions are monitored in the unit for 2 hours following the infusion first four infusions, 1 hour following infusions 5–9 and 30 min for each infusion thereafter. For VDZ, a 2 hour observation period following the first 2 infusions is recommended. The introduction of ustekinumab, licensed without a defined post infusion observation period, led us to consider the need for post infusion observation periods in other patient groups. Methods We reviewed patient records of all patients receiving IFX and VDZ infusions in our clinic between September 2016 and September 2017 to identify infusion reactions and document when these occurred. Results 1152 infusions of IFX and 330 infusions of VDZ were administered over the 12 month period. The total post-infusion observation time for these patients was 953 hours. 10 infusion reactions occurred (0.9%), all in patients receiving IFX. 6/10 (60%) occurred within 10 mins of starting IFX infusion (immediate), 2/10 (20%) later during the infusion (acute), and 1/10 (10%) occurred 2 weeks after receiving the infusion (delayed). No infusion reactions occurred during the post-infusion observation period. No infusion reactions occurred in patients receiving VDZ. Conclusions We analysed 953 post-infusion observation hours after 1152 IFX and VDZ infusions in our unit over a one-year period. The total infusion reaction rate was 0.9% (10/1152). Of note, none of these occurred during the post-infusion period. The results from this large single centre retrospective study demonstrate that the risk of onset of adverse reactions to either IFX or VDZ during the post infusion observation period is very low. Patients who have not had a reaction during the infusion do not routinely need to stay in the unit for post infusion observation. We hope that by formally adapting this strategy we will better manage the increasing demands on our capacity, whilst still providing safe and appropriate care to our patients.