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Pusateri A, Hatcher A, Patel N, Lehman J, Hinton A, Afzali A. Impact of rapid infliximab infusions on access at a large academic tertiary medical center. Am J Health Syst Pharm 2021; 78:2046-2052. [PMID: 34050749 DOI: 10.1093/ajhp/zxab225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Infliximab promotes remission in patients with inflammatory bowel disease (IBD) and rheumatologic disease (RD). Rapid infliximab infusions (RI) reduce infusion time from 2 hours to 1 hour and can enhance access to care, as defined by capacity, safety, and patient characteristics. Our hypothesis for the study described here was that use of RI can enhance access for patients. METHODS Data on all patients receiving infliximab for IBD or RD at our outpatient infusion center from February 2016 to August 2017 were retrospectively analyzed. Demographic and clinical information were collected. RESULTS Of 348 patients who received infliximab, 205 had IBD and 143 had RD. In terms of capacity, 40% of patients received RI, resulting in a 16.1% decrease in average daily infusion time and a 9.8% increase in average daily available scheduled infusion chair time (P = 0.720). In terms of safety, 4 patients switched back to standard infusions after RI, after 3 specifically had reactions to RI. In terms of patient characteristics, more patients with RD versus IBD received RI (P = 0.020). Among the patients with RD, a lower proportion receiving RI were female (P = 0.043). For the patients with IBD, a higher proportion receiving RI were white (P = 0.048). Among both patients with RD and patients with IBD, a higher proportion receiving RI had private insurance (P = 0.016 and P = 0.018, respectively). CONCLUSION RI were safe and increased available chair time. Females with RD, patients of non-White race with IBD, and patients with public insurance were less likely to receive RI. Future directions include patient surveys and evaluation of implicit bias against patient factors that may impact access to RI.
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Affiliation(s)
- Antoinette Pusateri
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashley Hatcher
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH, and The Ohio State University Inflammatory Bowel Disease Center, The Ohio State University, Columbus, OH, USA
| | - Nisha Patel
- The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Joy Lehman
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Anita Afzali
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH, and The Ohio State University Inflammatory Bowel Disease Center, The Ohio State University, Columbus, OH, USA
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Munsel EJ, Bryan PJ, Binstadt BA, Bullock D, Correll CK, Downs EM, Hobday PM, Larson-Nath C, Sudel B, Vehe RK. Rapid Infliximab Infusion in the Pediatric Population. J Pediatr Pharmacol Ther 2020; 25:705-708. [DOI: 10.5863/1551-6776-25.8.705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES
To compare infusion reaction rates between rapid infliximab (REMICADE, Janssen Biotech Inc) infusions and previous standard 2- to 3-hour infusions; additionally, to assess patient satisfaction and reduction in chair time associated with rapid infliximab infusions.
METHODS
Pediatric rheumatology and gastroenterology patients receiving maintenance infliximab therapy using a standard 2- to 3-hour titrated infusion had the opportunity to enroll in the non-titrated rapid 1-hour infusion protocol following tolerance of induction dosing at 0, 2, and 6 weeks. Patients were included from December 1, 2017, to March 31, 2018, via retrospective chart review and patient satisfaction surveys.
RESULTS
Data were collected on 55 patients receiving a total of 160 rapid infliximab infusions. There were 2 infusion reactions during the enrollment and data collection period, resulting in an overall infusion reaction rate of 1.3%. The patient satisfaction survey results showed all patients were at minimum satisfied with the information provided regarding rapid infliximab, decreased time spent in clinic, ease of scheduling, and overall process.
CONCLUSIONS
Our data suggest rapid infliximab infusions are safe in pediatric rheumatology and gastroenterology patients receiving maintenance infliximab infusion therapy. The overall infusion reaction rate of 1.3% in this study is well below the accepted infusion reaction rate of standard-length infliximab infusions of 2% to 3%.
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Affiliation(s)
- Erin J. Munsel
- Department of Pharmacy (EJM, PJB), University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Peter J. Bryan
- Department of Pharmacy (EJM, PJB), University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Bryce A. Binstadt
- Division of Pediatric Rheumatology (BAB, DB, CKC, PMH, RKV), University of Minnesota, Minneapolis, MN
| | - Danielle Bullock
- Division of Pediatric Rheumatology (BAB, DB, CKC, PMH, RKV), University of Minnesota, Minneapolis, MN
| | - Colleen K. Correll
- Division of Pediatric Rheumatology (BAB, DB, CKC, PMH, RKV), University of Minnesota, Minneapolis, MN
| | - Elissa M. Downs
- Division of Pediatric Gastroenterology (EMD, CLN, BS), University of Minnesota, Minneapolis, MN
| | - Patricia M. Hobday
- Division of Pediatric Rheumatology (BAB, DB, CKC, PMH, RKV), University of Minnesota, Minneapolis, MN
| | - Catherine Larson-Nath
- Division of Pediatric Gastroenterology (EMD, CLN, BS), University of Minnesota, Minneapolis, MN
| | - Boris Sudel
- Division of Pediatric Gastroenterology (EMD, CLN, BS), University of Minnesota, Minneapolis, MN
| | - Richard K. Vehe
- Division of Pediatric Rheumatology (BAB, DB, CKC, PMH, RKV), University of Minnesota, Minneapolis, MN
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Safety and Tolerability of Accelerated Infliximab Infusions in Patients With Inflammatory Bowel Disease. Am J Gastroenterol 2019; 114:352-354. [PMID: 30333541 DOI: 10.1038/s41395-018-0368-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Infliximab for inflammatory bowel disease (IBD) is FDA-approved to be administered 2 h or more. We adopted a new protocol to infuse infliximab over 1 h and in this study, we aimed to determine the safety of a 1-h infusion. METHODS This retrospective cohort included adult IBD patients who received infliximab between June and December 2017 and compared reaction rates of 1-h maintenance infusions to that of 2-h maintenance infusions. RESULTS A total of 551 infusions were administered to 179 patients. The infusion groups demonstrated no significant differences in reaction rates. CONCLUSIONS Infliximab infusion over 1 h is well-tolerated.
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Rozette NA, Hellauer CM, McKee C, Vazifedan T, Gabriel CA, Dice JE, Yokois NU. Evaluation of Rapid vs Standard Infliximab Infusions in the Pediatric Population. Inflamm Bowel Dis 2018; 24:2007-2014. [PMID: 29788416 DOI: 10.1093/ibd/izy093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Rapid 1-hour infliximab infusions have been safely implemented in adults, but studies of these rapid infusions in pediatric patients are limited. This study's primary objective was to determine the safety of 1-hour infliximab infusions compared with standard 2- to 3-hour infusions in children with inflammatory bowel disease and other autoimmune disorders. METHODS We conducted an institutional review board-approved prospective study using an unmatched historical control group at a freestanding children's hospital comparing rapid vs standard infusion rates of infliximab and the use of premedications and immunomodulatory agents on the frequency of early and delayed infusion reactions. RESULTS There were 50 subjects with 540 total standard (2- to 3-hour) infusions in the retrospective group and 66 subjects with 545 total rapid (1-hour) infusions assessed in the prospective group. Although the prospective group received a significantly higher infliximab dose, was significantly less likely to receive premedication, and was significantly more likely to receive another immunomodulatory agent, only 2 instances of potential infusion reactions occurred in the 545 rapid infusions (0.36%; 95% confidence interval [CI], 0.22%-11.01%; 3% of patients) administered in the prospective group compared with 1 documented infusion reaction (0.19%; 95% CI, 0.0%-11.47%; 2% of patients) in the retrospective group (odds ratio, 0.65; 95% CI, 0.01-12.93; P = 0.99). CONCLUSIONS This study suggests that rapid infusion of infliximab over 1 hour is not associated with an increased risk of infusion reactions when compared with standard 2- to 3-hour infusions and can be safely used in children with no previous reaction to standard infusions to treat inflammatory bowel disease and other autoimmune diseases.
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Affiliation(s)
- Nicole A Rozette
- Department of Pharmacy, Carilion Clinic Roanoke Memorial Hospital, Roanoke, Virginia
| | - Christina M Hellauer
- Department of Pharmacy, Children's Hospital of The King's Daughters.,Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
| | - Chephra McKee
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas
| | - Turaj Vazifedan
- Department of Pediatrics, Children's Hospital of The King's Daughters
| | - Christos A Gabriel
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia.,Division of Pediatric Rheumatology, Children's Hospital of The King's Daughters
| | - James E Dice
- Department of Pharmacy, Children's Hospital of The King's Daughters.,Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
| | - Nancy U Yokois
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia.,Division of Pediatric Gastroenterology, Children's Hospital of The King's Daughters
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Mazzuoli S, Tricarico D, Demma F, Furneri G, Guglielmi FW. Accelerated Infliximab Infusion: Safety, Factors Predicting Adverse Events, Patients' Satisfaction and Cost Analysis. A Cohort Study in IBD Patients. PLoS One 2016; 11:e0166443. [PMID: 27851772 PMCID: PMC5112916 DOI: 10.1371/journal.pone.0166443] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/28/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Standard Infliximab infusion consists of a 2-hour intravenous administration. Recently, Infliximab shortened infusion has been included in the Infliximab label as possible maintenance regimen for patients tolerating Infliximab induction therapy. AIM To verify if accelerated 1-hour Infliximab infusions are as safe as standard administrations, in patients with Inflammatory Bowel Disease. METHODS Seventy-four patients treated between September 2008 and November 2014 were evaluated. Patients were eligible for 1-hour infusion if they had no history of infusion reactions during the previous 2-hour infusions. RESULTS Twenty-three patients received 2-hour infusions, 16 patients received 1-hour infusions, 35 patients received 2-hour infusions followed by 1-hour infusions. A total of 1,123 Infliximab infusions were administered. The proportion of patients experiencing infusion reaction was: 4% over the 1-hour infusions and 9% over the 2-hour (P = 0.318). Adverse reaction/infusion rate was 0.55% over the 1-hour infusions and 0.66% over the 2-hour (P = 0.835). In the logistic model, accelerated infusion was the only statistically significant predictor of infusion reaction risk reduction (-90%; P = 0.024). Mean satisfaction was 8/10 (±0.84) with 1-hour regimen and 6/10 (±0.56) with 2-hour infusions (P = 0.000). The mean total cost was reduced by 47% with the 1-hour regimen (133.54€ and 250.86€ for 1-hour and 2-hour infusions, respectively). CONCLUSIONS Accelerated Infliximab infusion does not increase the acute infusion reaction incidence. In patients with inflammatory bowel disease, the 1-hour regimen should be preferred to 2-hour protocol also due to positive effects on indirect costs and patient's satisfaction.
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Affiliation(s)
- S. Mazzuoli
- Gastroenterology & Artificial Nutrition Dept., “San Nicola Pellegrino” Hospital, Trani (BT), Italy
| | - D. Tricarico
- Department of Pharmacology and Pharmaceutical Sciences, University of Bari “Aldo Moro”, Bari, Italy
| | - F. Demma
- Health Economics & Outcome Research Department - EBMA Consulting, Milano, Italy
| | - G. Furneri
- Health Economics & Outcome Research Department - EBMA Consulting, Milano, Italy
| | - F. W. Guglielmi
- Gastroenterology & Artificial Nutrition Dept., “San Nicola Pellegrino” Hospital, Trani (BT), Italy
- * E-mail:
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Michielan A, Martinato M, Favarin A, Zanotto V, Caccaro R, Caruso A, Sturniolo GC, D'Incà R. A nurse-led accelerated procedure for infliximab infusion is well tolerated and effective in patients with inflammatory bowel disease. Dig Liver Dis 2015; 47:372-7. [PMID: 25708258 DOI: 10.1016/j.dld.2015.01.152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Shorter infusions of infliximab for inflammatory bowel disease seem to be as tolerated as standard procedures and nurses may be able to manage them safely. AIMS To test tolerability and effectiveness of a fast nurse-led infusion procedure and the related patients' satisfaction. METHODS We retrospectively compared three different regimens adopted in our outpatient infusion unit from 2010 to 2013: Group 1, a standard procedure with two-hour infusions, preceded by hydrocortisone medication (87 patients, 311 infusions); Group 2, a similar regimen without physician supervision (130 patients, 464 infusions); Group 3, a one-hour nurse-led procedure without routine premedication (176 patients, 1356 infusions). Disease characteristics, infusion reactions, infusions per month and patients' satisfaction were recorded. RESULTS There were significantly fewer infusion reactions in Group 3 than Group 1 (2.2% versus 5.8% respectively; p=0.001). The only significant risk factor for side effects was premedication (odds ratio 4.71, 95% confidence interval 2.21-10.02, p<0.001) which was related to the presence of previous side effects. Number of infusions per month increased by 27% (83 versus 61, p<0.001) without increasing nurses' workload and patients were satisfied. CONCLUSIONS Our fast nurse-led procedure was well tolerated, effective and satisfactory for patients.
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Affiliation(s)
- Andrea Michielan
- Department of Surgical, Gastroenterological and Oncological Sciences, Azienda Ospedaliera - Università di Padova, Padua, Italy.
| | - Matteo Martinato
- Clinical Research Unit, Azienda Ospedaliera - Università di Padova, Padua, Italy
| | - Andrea Favarin
- Department of Surgical, Gastroenterological and Oncological Sciences, Azienda Ospedaliera - Università di Padova, Padua, Italy
| | - Viviana Zanotto
- Department of Surgical, Gastroenterological and Oncological Sciences, Azienda Ospedaliera - Università di Padova, Padua, Italy
| | - Roberta Caccaro
- Department of Surgical, Gastroenterological and Oncological Sciences, Azienda Ospedaliera - Università di Padova, Padua, Italy
| | - Antonino Caruso
- Department of Surgical, Gastroenterological and Oncological Sciences, Azienda Ospedaliera - Università di Padova, Padua, Italy
| | - Giacomo Carlo Sturniolo
- Department of Surgical, Gastroenterological and Oncological Sciences, Azienda Ospedaliera - Università di Padova, Padua, Italy
| | - Renata D'Incà
- Department of Surgical, Gastroenterological and Oncological Sciences, Azienda Ospedaliera - Università di Padova, Padua, Italy
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Law EC, Sideridis GD, Prock LA, Sheridan MA. Attention-deficit/hyperactivity disorder in young children: predictors of diagnostic stability. Pediatrics 2014; 133:659-67. [PMID: 24639272 PMCID: PMC3966508 DOI: 10.1542/peds.2013-3433] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals of this study were (1) to provide estimates of diagnostic stability for a sample of young children diagnosed with attention-deficit/hyperactivity disorder (ADHD) after undergoing comprehensive multidisciplinary assessments and (2) to identify baseline child and family characteristics that predict diagnostic stability over time. METHODS Children aged 3 to 6 years, 11 months consecutively diagnosed with ADHD after multidisciplinary consultations at a tertiary care clinic between 2003 and 2008 were recontacted in 2012 and 2013 (N = 120). At follow-up, the primary outcome was the proportion of children who continued to meet diagnostic criteria for ADHD. To identify predictors of diagnostic stability, logistic regression models were used. In addition, a latent class model was used to independently classify subjects into distinct clusters. RESULTS In this cohort, 70.4% of the children contacted at follow-up continued to meet diagnostic criteria for ADHD. Predictors of diagnostic stability included externalizing and internalizing symptoms at baseline, parental history of psychopathology, and family socioeconomic status. The latent class model independently identified 3 distinct profiles: (1) children who no longer met ADHD criteria; (2) children with persistent ADHD and high parental psychopathology; and (3) children with persistent ADHD and low family socioeconomic status. CONCLUSIONS Young children who underwent comprehensive developmental and psychological assessments before receiving an ADHD diagnosis, had higher rates of diagnostic stability than in previous studies of community samples. Child and family factors that predict diagnostic stability have the potential to guide treatment planning for children diagnosed with ADHD before 7 years of age.
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Affiliation(s)
| | - Georgios D. Sideridis
- Clinical Research Center, Boston Children’s Hospital, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts; and
| | - Lisa Albers Prock
- Division of Developmental Medicine, and,Harvard Medical School, Boston, Massachusetts; and
| | - Margaret A. Sheridan
- Division of Developmental Medicine, and,Harvard Medical School, Boston, Massachusetts; and,Harvard Center on the Developing Child, Harvard University, Cambridge, Massachusetts
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Neef HC, Riebschleger MP, Adler J. Meta-analysis: rapid infliximab infusions are safe. Aliment Pharmacol Ther 2013; 38:365-76. [PMID: 23815183 DOI: 10.1111/apt.12389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 01/18/2013] [Accepted: 06/06/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Infliximab is typically administered intravenously via 2- to 3-h duration infusions. Infusions are time-consuming and costly. Shorter duration infusions are administered at some centres. Limited safety data are available on shorter duration infusions. AIM To determine risk of infusion reaction associated with standard 2- to 3-h infusions vs. rapid infusions in patients receiving infliximab therapy for inflammatory bowel disease (IBD), rheumatoid arthritis, spondylarthopathy and psoriatic disease. METHODS MEDLINE, Embase, and Web of Science were searched. Inclusion required human subjects, documentation of number of standard and rapid infliximab infusions and number of incident infusion reactions. Studies of overlapping populations were excluded. Three reviewers independently extracted data. Study quality was assessed. Relative risk (RR) was pooled using random effects models. RESULTS We identified 10 studies comprising 13 147 standard 2- to 3-h and 8497 ≤ 1-h infliximab infusions. Nine studies reported the risk of infusion reaction in standard vs. 1-h infusions, demonstrating decreased RR of infusion reaction with 1-h vs. standard infusions (0.9% vs. 2.2% of infusions; RR = 0.48, P = 0.009). Seven studies limited to IBD also demonstrated decreased risk of reaction (RR = 0.49, P = 0.002). Other comparisons demonstrated no difference in RR of reaction, including concomitant medication use (P = 0.30) or analysis limited to high and medium quality studies (P = 0.07). CONCLUSIONS Rapid infliximab infusions of ≤1-h duration are not associated with increased risk of infusion reaction when compared to standard 2- to 3-h infusions in selected patients who previously tolerated three to four standard infusions. One-hour infusions will conserve health care resources and may lead to improved adherence and quality of life in patients receiving infliximab.
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Affiliation(s)
- H C Neef
- Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109-5718, USA
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