Rapid Infliximab Infusions Are Safe and Well Tolerated in Inflammatory Bowel Disease Patients

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Introduction: Infliximab infusion over 2 hours is approved for the treatment of inflammatory of bowel disease (IBD). Given the need for repeated infusions, shorter infusion duration could result in increased patient satisfaction by time savings and increase infusion efficiency. Primary aim of our study was to evaluate the safety and time savings of rapid infliximab infusions. Methods: All patients who received infliximab infusion as part of their IBD treatment between January 2012 and December 2015 were retrospectively reviewed. Patients on stable doses (5 mg/kg to 10 mg/kg) of infliximab infusion over two hours were offered accelerated infusion over 90 minutes and, if tolerated well, were transitioned to 60 minutes. Patients were reverted back to standard 120 minutes infusion on development of any side effects or poor tolerance. The use of pre-medications (acetaminophen and antihistamines), any systemic steroids during infusion and concomitant immunomodulator (methotrexate, azathioprine or 6-MP) use was also noted. Results: The 88 patients receiving infliximab infusions that fulfilled inclusion criteria were further divided into 3 groups based on infusion duration (2 hours, 90 minutes, 60 minutes). All patients received antihistamine and acetaminophen prior to the infusion. The 2-hour infusion group included 45 patients (33 CD; 12 UC) with a mean age of 44 years. Among these, 36 patients were on 5mg/kg and 9 patients were on 10 mg/kg dose. No infusion related adverse events were noted. The 90-minute infusion group included 10 patients (5 CD, 5 UC, mean age of 53 years). All of them were on 5 mg/kg infusion dose. One patient reported chills at infusion initiation, which subsided with promethazine and solumedrol. The 1-hour group included 33 patients (12 UC,21 CD, mean age 35 years, 8 patients on 5 mg/kg, 1 patient on 7.5 mg/kg and 24 patients were on 10 mg/kg dose). One patient experienced flushing/awkwardness at her initial 60-minute infusion which subsided after promethazine and methylprednisone. No other adverse infusion reactions were noted. No patient needed discontinuation or reversion of infusion regimens. For the total 151 infusions, 121 hours (7260 minutes) were saved by accelerated infusions (60 and 90 minutes). Conclusion: The rapid infusion of infliximab for the treatment of IBD is safe and is associated with significant amount of time saved, both for patients improving their satisfaction and increasing efficiency at our infusion facility.