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Premedication Use Before Infliximab Administration: A Cross-sectional Analysis.

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Area of Science:

  • Gastroenterology
  • Clinical Practice Research
  • Pharmacology

Background:

  • Premedications are frequently administered to patients with inflammatory bowel disease (IBD) prior to intravenous infliximab therapy.
  • Significant variability exists in current premedication practices for IBD patients receiving infliximab.
  • Understanding clinician rationale is crucial for optimizing premedication strategies.

Purpose of the Study:

  • To describe the variability in premedication practices among clinicians treating IBD patients.
  • To determine the underlying rationale for premedication use before infliximab administration in IBD.
  • To assess clinicians' knowledge regarding premedication efficacy and adverse events.

Main Methods:

  • A cross-sectional electronic survey was developed following a literature review.
  • The survey assessed practice variability and clinician rationale for premedication use.
  • Distribution occurred via professional society listservs and discussion boards, with an optional knowledge assessment quiz.

Main Results:

  • 379 gastroenterologists (pediatric and adult) responded, with a 93.3% completion rate.
  • Acetaminophen (66%) and diphenhydramine (64%) were the most common premedications.
  • Significant heterogeneity in premedication use was observed within and between clinical practices; only 18% correctly identified diphenhydramine's association with increased reactions.

Conclusions:

  • High variability exists in premedication use before infliximab for IBD patients.
  • Clinician rationale appears driven by individual preference and practice habits rather than evidence.
  • Enhanced understanding of evidence may reduce overuse of certain premedications, especially diphenhydramine.