Background/Purpose:

The goals of this report are to describe various therapeutic protocols, volume of intravenous (IV) infusions, and associated adverse events at the University of Alabama at Birmingham (UAB) Pediatric Rheumatology Infusion Center from 2012 through 2015.

Methods:

This was an institutional review board (IRB) approved retrospective chart review of 7,585 IV infusions given to 398 patients from 2012-2015. Infusion medications included abatacept, belimumab, cyclophosphamide, immune globulin (IVIG), infliximab, methylprednisolone, N-acetylcysteine, pamidronate disodium, rituximab, and tocilizumab. For calendar year 2015, all adverse reactions were recorded along with management strategies and outcomes. Rates of adverse events were calculated per infusion medication.

Results:

During calendar year 2015, 234 patients received 2,181 infusions. Newer biologics (other than IVIG) represented 59% of the total IV infusions given. Of the 234 patients, 37 experienced 45 infusion reactions. The total adverse event rate for all infusions was 2%. Medications with infusion reactions were abatacept, infliximab, immune globulin, methylprednisolone, rituximab, and tocilizumab. Rituximab had the highest rate of adverse drug reactions with 11 patients experiencing reactions during 107 infusions (10%), mainly allergic in nature, while infliximab had the lowest rate of those with reactions with 7 adverse events occurring from 818 infusions (0.8%). All reactions were mild and resolved on slowing the infusion rate and treatment with antihistamines, corticosteroids, analgesics, anti-emetics, or epinephrine as needed.

Conclusion:

In recent years, the UAB Pediatric Rheumatology Infusion Center has treated a wide variety of diagnoses and given thousands of IV infusion. Adverse reactions were few and mostly mild and transient. The use of standardized infusion protocols, the experience of managing physicians and nurses, along with the safety of the medications themselves, allow for safe IV infusions for pediatric rheumatology patients, and provide examples for similar and future infusion centers. Of note, this study does not explore potential later events, such as cancer or tuberculosis, for example.

Table 1. Diagnoses Treated from 2012-2015

Table 2. Total Infusions given from 2012-2015 listed by medication

Table3. Number of infusion reactions in 2015