Shorter infliximab infusion times without premedication do not increase adverse reactions

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.