Accelerated infliximab infusions are safe and well tolerated in patients with inflammatory bowel disease

Infliximab is used widely for patients with inflammatory bowel disease (IBD). Drug manufacturers advise a 2-h infusion, with subsequent monitoring for a further 2-h period. Accelerated infusions, however, have been used in rheumatological patients with no significant increase in adverse events reported.

The primary endpoint was to assess the incidence of infusion reactions in IBD patients receiving infliximab via an accelerated infusion protocol. Secondary endpoints were to identify factors that may increase risk of an infusion reaction.

This was a prospective study examining patients with IBD receiving infliximab with the accelerated infusion protocol (first four infusions over 2 h, with 2 h of monitoring, the next five infusions over 1 h, and subsequent infusions over 30 min).

Over 40 months, 1146 infusions were administered to 144 patients, 139 patients with Crohn's disease, two with ulcerative colitis, two with pouchitis and one with indeterminate colitis. Fourteen reactions during the 2-h infusion, with four delayed hypersensitivity reactions were observed, 13 during 1-h infusions with one delayed hypersensitivity reaction and 10 during a 30-min infusion. Thirty-two reactions were mild, allowing completion of the infusion, but five were severe, resulting in cessation of infliximab. Sex, age, disease type (fistulising vs. inflammatory), administration (episodic vs. maintenance infusions), type of immunomodulator or number of infusions were not predictors of an infusion reaction.

Rapid infusion of infliximab is safe and well tolerated, with no increase in infusion-related reactions. Where reactions do occur, they are usually mild, allowing completion of therapy.