Shorter infliximab infusion times without premedication do not increase adverse reactions

Infliximab (IFX) infusions for paediatric inflammatory bowel disease (IBD) are resource intensive and time-intrusive on patient's lives. Longer infusion times and administering routine pre-medications compound such timelines, despite limited supporting evidence. This study investigated whether discontinuing routine premedication and shortening IFX infusion durations increased infusion reaction rates.

This retrospective comparative cohort study analysed data from 1083 IFX infusions (369 patients) at a single national referral centre. It compared a cohort receiving routine dual hydrocortisone/chlorphenamine premedication with longer infusion times (2.5 h induction/90 min maintenance; Group A) with a subsequent cohort without universal premedication and shorter infusions (2 h induction/60 min maintenance; Group B). The primary outcome was the rate of acute infusion reactions; secondary outcomes included anti-IFX antibody formation and rates of post-infusion reactions.

There were 346 infusions in Group A and 737 infusions in Group B. Shorter infusions and omitting routine premedication did not increase acute infusion reaction rates (Group A: 1.5/100 vs. Group B: 1.1/100 infusions, p = 0.6; odds ratio 0.75 [0.24, 2.3]). Universal premedication neither reduced early anti-IFX antibody positivity by first maintenance dose (n = 51; 33% vs. 17%, p = 0.23) nor overall antibody prevalence (31% vs. 37%, p = 0.164). No reactions occurred during extended post-infusion observation periods in either group.

Neither longer infusion times, universal pre-medication nor prolonged post-infusion observation significantly enhanced patient safety or reduced anti-drug antibody formation. Practice modification could reduce treatment burden for patients and families and improve healthcare efficiency.