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Canadian Journal of Gastroenterology
Volume 24, Issue 5, Pages 307-311
Original Article

The Safety of Infliximab Infusions in the Community Setting

James Ducharme,1 Cindy Pelletier,2 and Ramesh Zacharias3

1Department of Medicine, McMaster University, Hamilton, Canada
2AIM Health Group, Canada
3Centres for Pain Management, Mississauga, Ontario, Canada

Received 2 September 2009; Accepted 15 October 2009

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Tumour necrosis factor-alpha (TNFα) has an important role in the pathogenesis of inflammatory conditions such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis and psoriasis. Infliximab, a chimeric anti-TNFα monoclonal antibody, has been shown to reduce the severity of symptoms or induces remission of active disease. Infusions have generally been limited to the hospital setting due to cost and concerns for patient safety. Studies defining its efficacy and safety have, therefore, originated almost exclusively from hospital settings.

OBJECTIVE: To evaluate the safety of infliximab in a community clinic environment, across all types of patients.

METHODS: A retrospective chart review of 3161 patients who received a combined 20,976 infusions at a network of community clinics over 16.5 months was conducted. Adverse drug reaction (ADR) information was retrieved and coded for time of onset, severity and outcome. Only ADRs that occurred during or within the first 24 h of the infusion were included.

RESULTS: A total of 524 (2.5% of all infusions) acute ADRs in 353 patients (11.2%) were recorded. Most reactions (ie, ADRs) were mild (n=263 [50.2%, 1.3% of all infusions]) or moderate (n=233 [44.5%, 1.1% of all infusions]). Twenty-eight reactions (5.3%, 0.1% of all infusions) were severe. Emergency medical services were called to transport patients to hospital for seven of the severe reactions, of which none required admission. As per pre-established medical directives, adrenaline was administered three times.

CONCLUSIONS: Infliximab infusions are safe in the community setting. Severe ADRs were rare. None required active physician intervention; nurses were able to treat all reactions by following standardized medical directives.