Low Doses of Glucocorticoids May Decrease Risk for Infusion Reactions in RA Patients Taking Infliximab

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Low Doses of Glucocorticoids May Decrease Risk for Infusion Reactions

in RA Patients Taking Infliximab: Presented at EULAR

By Jerry Ingram

VIENNA, AUSTRIA -- June 14, 2005 -- Treatment with a low dose of

glucocorticoids in patients receiving infliximab for rheumatoid

arthritis appears to reduce the risk for infusion reactions, according

to research presented here on June 11th at EULAR 2005, the European

Congress of Rheumatology.

" We found that there is a certain amount of protection from infusion

reactions when patients have a low dose of glucocorticoid --

prednisone, that is, " explained Augustsson, PharmD/PhD student,

department of rheumatology, Karolinska University Hospital, Solna,

Sweden.

Dr. Augustsson and colleagues collected data from the Stockholm

TNF-alpha Follow-Up Registry (STURE) on 43 patients who experienced

infusion reactions (anaphylactic/anaphylactoid reaction and/or

urticaria and itching) that required them to cease treatment with

infliximab.

Dr. Augustsson and colleagues evaluated the data to compare the

characteristics of patients who had reactions and those of 639 controls

who were matched for gender, diagnosis, and age.

The investigators measured patient scores on the Health Assessment

Questionnaire (HAQ), Disease Activity Score (DAS28), Visual Analog

Scale (VAS) and pain, number of swollen joints, number of tender

joints, duration of disease at start of treatment, number of failed

disease-modifying antirheumatic drugs (DMARDs) before initiation of

treatment, and oral glucocorticoid dose.

To make comparisons, the researchers used student t-test for normally

distributed continuous, chi-square test for nominal variables, and

Mann-Whitney test and Wilcoxon test for all other variables. Logistic

regression was used in the case-control study and to determine odds

ratios.

They found that 54% of patients were on a daily low dose of

glucocorticoids at baseline. Among these, significantly fewer patients

experienced infusion reactions compared with those who did not use

glucocorticoids (5.7% vs 12.7%, P =.007; odds ratio 2.4; 95% confidence

interval 1.3-4.6).

In the matched comparisons (cases versus infliximab cohort and cases

versus matched controls) investigators noted that 35% of 43 patients

were on low-dose glucocorticoids compared with 64% of 42 controls (P

=.007).

They also observed a significant difference in number of DMARDs before

treatment with infliximab versus controls (cases 3.65 vs 2.61, P

=.0115). Using logistic regression, they found that the HAQ, DAS28,

number of DMARDs, and erythrocyte sedimentation rate serve as

independent predictors of infusion reactions.

However, Dr. Augustsson said that the overall predictive power of these

parameters remained low.

Finally, the researchers noted that the proportion of infusions

associated with infusion reactions decreased significantly from 1999 to

2004 (P =.0009).

" We're wondering why this happened. It could be that we're starting

with younger patients who are stronger or it could be that clinicians

know which patients are likely to have reactions. I'm currently writing

an article on possible explanations for this, " Dr. Augustsson

concluded.

This study was funded by Apoteket.

[Presentation title: Daily Low-Dose Glucocorticoid Therapy Decreases

Risk for Treatment-Limiting Infusion Reactions to Infliximab. Abstract

0079]