Reactions to Infliximab Infusions in Dermatologic Patients: Consensus Statement and Treatment Protocol

Puig, L.; Sáez, E.; Lozano, M.J.; Bordas, X.; Carrascos, J.M.; Gallardo, F.; Luelmo, J.; Sánchez-Regaña, M.; Alsina, M.; García-Patos, V.

doi:10.1016/S1578-2190(09)70025-3

Actas Dermo-Sifiliográficas

ISSN: 0001-7310

The Official publication of the Spanish Academy of Dermatology and Venereology (AEDV). Actas Dermo-Sifiliográficas, founded in 1909, is the oldest monthly medical journals published in Spain. In the year 2006 has been indexed in the Medlinedatabase, and has become a vehicle for expressing the most current Spanish medicine and modern. All articles are subjected to a rigorous process of revision in pairs, and careful editing for literary and scientific style. Together with the classic Original and Clinical Case Study sections, we also include Reviews, Case Diagnoses, and Book Reviews. Dermo-Sifiliográficas is an essential publication for anyone who needs to be current on all aspects of Spanish and world dermatology.

Con su JCI 2023, Actas Dermo-Sifiliográficas es Q1 y se posiciona la revista nº 15 de 94 en Dermatología

With JCI 2023, Actas Dermo-Sifiliográficas is Q1 and is ranked number 15 of 94 in Dermatology

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Infliximab is a chimeric monoclonal antibody that binds to and blocks tumor necrosis factor α and is the most effective biologic agent approved for the treatment of moderate-to-severe psoriasis. It is administered by intravenous infusion, usually in day hospitals on an outpatient basis. The main problem with the administration of infliximab is the possibility of infusion reactions, which may be immediate or delayed; these reactions are related to the immunogenicity of this monoclonal antibody, leading to the production of anti-infliximab antibodies. Infusion reactions to infliximab are not usually anaphylactic (ie, they are not mediated by immunoglobulin E), and re-exposure of the patient using specific protocols to prevent and treat these reactions is therefore possible. The extensive experience in the use of infliximab for the treatment of rheumatic conditions and chronic inflammatory bowel disease has made it possible to develop infusion reaction management protocols; these can be applied to dermatologic patients, who constitute a growing proportion of patients treated with intravenous biologic agents. The aim of this review is to draw up a consensus protocol for the treatment of infusion reactions in dermatologic patients treated with infliximab.

Key words:

infliximab

psoriasis

infusion reactions

monoclonal antibody

immunogenicity

Resumen

Infliximab, un anticuerpo monoclonal quimérico que se une y bloquea al factor de necrosis tumoral alfa, constituye el agente biológico más eficaz aprobado para el tratamiento de la psoriasis moderada a grave y se administra mediante infusión intravenosa, generalmente en Hospitales de Día de forma ambulatoria. Las reacciones infusionales, que pueden ser agudas y retardadas, constituyen el principal problema en la administración rutinaria de este fármaco, y están relacionadas con la inmunogenicidad del anticuerpo monoclonal que da lugar a la producción de anticuerpos dirigidos contra el mismo. Las reacciones infusionales a infliximab son en la mayoría de los casos no anafilácticas (mediadas por inmunoglobulina E [IgE]), lo que no excluye el retratamiento de los pacientes empleando protocolos específicos de prevención y tratamiento de las mismas. Existe una amplia experiencia sobre el uso de este fármaco en pacientes con enfermedades reumatológicas y enfermedad inflamatoria idiopática intestinal, lo que ha permitido desarrollar protocolos de tratamiento de las reacciones a la infusión aplicables a los pacientes dermatológicos, que constituyen un grupo cada vez más numeroso de los que son tratados con agentes biológicos por vía intravenosa. El objeto de la presente revisión es desarrollar un protocolo de tratamiento consensuado de las reacciones a la infusión en pacientes dermatológicos tratados con infliximab.

Palabras clave:

infliximab

psoriasis

reacciones a la infusión

anticuerpo monoclonal

inmunogenicidad

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