Azathioprine, 6-mercaptopurine and thiopurine s-methyltransferase levels in gastroenterology and rheumatology: a comparison of clinical practice in Australia. J Gastroenterol Hepatol 2009;24(s2):222–223. L BESWICK,1 L SOH,2 A MCFARLANE,1 DR VAN LANGENBERG1,2 1Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia, 2Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia Background: Infliximab (IFX) infusion reactions in patients with inflammatory bowel disease

(IBD) vary from minor urticaria to anaphylaxis. Although studies have previously observed infusion reactions in up to 10–50% of patients receiving infliximab infusions, anecdotally the prevalence appears far lower than this. To minimize reactions, standard infliximab infusions run over two hours with DNA-PK inhibitor two hours of post-infusion monitoring advised, yet many studies have shown more rapid infusion protocols to be safe and cost effective. Hence in a quality improvement initiative, we aimed to evaluate current practice of administering IFX infusions in patients with IBD and assess prevalence of IFX infusion reactions at a large volume, single IBD center, then evaluate predictive factors that are associated with an increased risk of an IFX infusion reaction. Methods: A retrospective audit of all patients with confirmed IBD who received IFX at Eastern Health between 1/1/2005- 1/1/2014 was conducted.

Data encompassing JNK inhibitor demographics, IBD clinical data, the number and time duration of IFX infusions plus the frequency, management and sequelae of infusion this website reactions were extracted from hospital records. Results: 2214 IFX infusions were administered to 169 patients throughout the nine-year period. The median number of infusions per patient was 10, with median age 38 (range 19–83) and 94 (56%) males; 126

(75%) patients had Crohn’s disease; 43 (25%) patients had ulcerative colitis. The median duration of IFX infusion was 2 hours 30 minutes (door-door at infusion unit) and 1 hour 25 minutes (start-finish infusion only) for their first documented infusion compared to 2 hours 15 minutes and 1 hour 15 minutes respectively for their most recently documented infusion. The adverse reaction rate per patient was 13.6%; 18 patients classified as having a mild reaction and 5 having a serious reaction (rate per patient 3.6%, per infusion 0.2%) according to the Common Toxicity Criteria. 17/18 (94%) with a mild reaction tolerated subsequent IFX infusions when rechallenged. According to multivariate analysis, predictive factors of an IFX infusion reaction included episodic or gap >3 months in IFX dosing (OR 8.7, 95% CI [1.8, 41.4], concurrent immunomodulator OR 9.4 [1.5, 57.4], smoker at time of reaction OR 3.8 [1.01, 13.9], duration of IBD when IFX started (per year, OR 1.11 [1.04, 1.2]) (each p < 0.05), with a non-significant trend for previous adverse drug reaction(s) OR 3.2 [0.8, 13.3] (p = 0.1).