Letter to the editors

LETTER TO THE EDITORS

DEAR EDITOR

The interesting study written by Barbosa CMPL et al. in the September/October 2008 issue of Revista Brasileira de Reumatologia about infusion reactions to infliximab in children and teenagers shows high incidence of reactions when compared with the adult population.¹

In the experience of Hospital Israelita Albert Einstein in São Paulo, this number is lower than 10%, and in those cases patients started to receive the drug without new reactions only by reducing the infusion speed.²

Authors will be able to enrich this paper if we have additional information:

1) When the drug was discontinued, did they not receive more infliximab infusion? If they were responding, did they migrate to another anti-TNF?

2) Some authors suggest some biomarkers indicating infusion reaction, for example, the presence of antinuclear antibodies. Other authors separate the presence of methotrexate from the incidence of infusion reactions. Authors should inform the use of methotrexate in those patients and the presence or absence of antinuclear antibodies.^3,4

3) What is the mean dose of prednisone in those patients? I believe all of them had been using a basal dose of steroids.

4) Finally, since most patients in previous papers did not present antiinfliximab antibodies, we should conclude that the presence of certain reactions does not exclude the possibility of readministration.

Morton Scheinberg

MD, Boston University; Reader (Immunology), Universidade de São Paulo, USP; Practitioner, Instituto Israelita de Ensino e Pesquisa Albert Einstein - IIEPAE; Scientific Director, Hospital Abreu Sodre - AACD (Hospital Unit of Musculoskeletal Disorders)

REFERENCES

• ¹
  Barbosa CM, Terreri MT, Oliveira S, Rodrigues MC, Bica BE, Sachetti S et al Efeitos adversos durante a infusão de infliximabe em crianças e adolescentes - estudo multicêntrico. Rev Bras Reumatol 2008;48(5):278-282.
• ²
  Scheinberg M, Goldenberg J, Feldman DP, Nóbrega JL. Retrospective study evaluating dose standards for infliximab in patients with rheumatoid arthritis at Hospital Israelita Albert Einstein, São Paulo, Brazil. Clin Rheumatol 2008;27(8):1049-52. Epub 2008 May 8.
• ³
  Grinblat B, Scheinberg M. The enigmatic development of psoriasis and psoriasiform lesions during anti-TNF therapy: a review. Semin Arthritis Rheum. 2008;7(4):251-5. Epub 2007 Jul 20. Review.
• ⁴
  Kapetanovic MC, Larsson L, Truedsson L, Sturfelt G, Saxne T, Geborek P. Predictors of infusion reactions during infliximab treatment in patients with arthritis. Arthritis Res Ther 2006;8(4):R131.

Publication Dates

• Publication in this collection
  07 July 2009
• Date of issue
  June 2009