Infusion reaction to monoclonal antibodies in outpatient infusion units of a university hospital – A two-year retrospective study
10.35460/2546-1621.2018-0052
- Author:
Joanna Luisa Z SALVADOR
1
;
Angelita T GARCIA
2
;
Flordeluna Z MESINA
2
Author Information
1. Department of Medicine University of Santo Tomas Hospital, Manila, Philippines
2. Department of Medicine, Section of Clinical Hematology University of Santo Tomas Hospital, Manila, Philippines
- Publication Type:Journal Article
- Keywords:
Infusion reaction
- MeSH:
Antibodies, Monoclonal;
Prevalence
- From:
Journal of Medicine University of Santo Tomas
2019;3(1):282-289
- CountryPhilippines
- Language:English
-
Abstract:
Introduction :Monoclonal antibodies have revolutionized the treatment of immune-mediated infl ammatory diseases (eg, rheumatoid arthritis [RA], Crohn’s
disease [CD], and psoriasis) as well as malignant
diseases. Currently, there are about 100 monoclonal
antibodies and even more are expected in the coming years. Knowledge of not only their mechanism
of action but also their adverse event profi le is tantamount. One of the distinctive side effects of these
drugs is the potential for non-allergic and allergic
infusion reactions caused by cytokine release. These
adverse reactions should be monitored and managed immediately for patient welfare and safety.
General Objective :To determine the prevalence
of infusion reaction among patients given monoclonal antibodies at outpatient infusion units of a
University Hospital, from July 2015 to July 2017.
Methodology :This is a two-year retrospective
study at the University of Santo Tomas Hospital
(USTH), a tertiary teaching hospital. A chart review
of patients seen at the USTH Benavides Cancer
Institute (BCI) and Joint and Bone Center (JBC) were
gathered. Patients who received monoclonal antibodies namely rituximab, infl iximab, bevacizumab,
tocilizumab, belimumab, brentuximab, pembrolizumab, trastuzumab, pertuzumab, nimotuzumab
and eculizumab from July 2015 to July 2017 were
included in the study.
Results :Majority of patients were in the 61 to 70
years age group (25.7%); the median age of the
population was 53 years and the majority were
females (64.9%). The most common indication for
monoclonal antibody infusion is rheumatoid arthritis
(28.4%). More than one-fourth of the patients did not
receive premedications (28.4%) but a good number
(25.7%) received at least two drugs: paracetamol
plus diphenhydramine plus corticosteroids followed
by 17.6% who received paracetamol plus diphenhydramine. The authors found a signifi cant difference
in the occurrence of infusion reaction between those
that were given premedications compared to those
who were not given premedications (p=0.032). The
most common monoclonal antibodies administered
were rituximab (28.4%); tocilizumab (23%); and infl iximab (14.9%). However, only rituximab (9.5%),
infl iximab (2.7%) and bevacizumab (1.4%) had infusion reactions. The overall incidence rate of infusion
reaction to monoclonal antibodies was 14%. The onset was within 2 hours with most infusion reactions
occurring in the fi rst cycle. Ninety percent were classifi ed as grade 2 infusion reactions. Management
of these reactions included rescue medications and
brief interruption of infusion. No hospitalization nor
recurrence of infusion reaction on the resumption of
infusion occurred.
Conclusions:The prevalence rate of infusion reaction to monoclonal antibodies was 14% in this present single-center two-year retrospective study. All adverse events were graded mild to moderate (grade
2) in severity, and were all accordingly managed
successfully in the outpatient setting.
- Full text:1 JMUST 5.pdf
