Introduction Infliximab is used in the treatment of inflammatory bowel disease. It is administered as an intravenous infusion over 2 h with a 2 h monitoring period. Accelerated infusions have been shown to be safe and well tolerated,1 reducing nursing time and increasing patient satisfaction.2 It has been suggested that post infusion monitoring may not be necessary,3 and it was our aim to establish this.
Methods 310 infusions were administered to 103 patients over 6 months (January to July 2013). Infusions 1–4 were administered over 2 h with 2 h monitoring, 5–9 over 1 h with 1 h monitoring, and 10 onwards over 30 mins with no monitoring.
A reaction was classified as mild if no action was required and severe if symptoms required immediate action or treatment withdrawal. A drop in systolic BP of ≥20 mm/Hg was recorded. Treatment of reaction and outcome were documented, including occurrence during or post infusion. Details of any delayed reactions post discharge were obtained from patient notes.
Results Of 41 patients receiving infusions 1–4, 2 patients (4.87%) had an infusion reaction. One mild, and one severe. Both occurred during the first infusion. Both had previously been treated with infliximab.
In 35 patients receiving infusions 5–9, 1 patient (2.86%) experienced a mild reaction during infusion 7, then a severe reaction during infusion 9.
No infusion reactions were observed during infusions 10+ (122 infusions in 37 patients). 11 patients had infusions 10+ over 1–2 h due to side effects with accelerated infusions or 10 mg/kg dose. These patients were not monitored post infusion.
One patient was hospitalised due to a delayed reaction one week after infusion 1 (previous infliximab treatment 108m). No side effects were observed during the infusion or monitoring period.
No reactions were recorded during the monitoring period in any of the treatment groups. One patient had a drop in systolic BP (22 mg/Hg) during the monitoring period of their 5th infusion. No action was taken and the patient was discharged.
Conclusion This audit has demonstrated that post infliximab monitoring is not necessary. We estimate that this would save 494 h of patient and nurse time per annum at our centre.
Donnellan CF, et al. Accelerated infliximab infusions are safe and well tolerated in patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2009;21(1):71–75
Saxena P, et al. Safety and cost benefit of an accelerated infliximab infusion protocol in the treatment of ambulatory patients with inflammatory bowel diseases. Expert Opin Biol Ther 2013 Dec 21 [Epub ahead of print]
Bhat S, et al. Are accelerated infliximab infusions safe in patients with inflammatory bowel disease? Inflammatory Bowel Disease 2010 Nov, 16 11;1922–5
Disclosure of Interest None Declared.