Skip to main content

Advertisement

Log in

Drug reactions in children with rheumatic diseases receiving parenteral therapies: 9 years’ experience of a tertiary pediatric rheumatology center

  • Pharmacovigilance
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Parenteral treatments (either subcutaneous or intravenous) are frequently used in rheumatology practice. In this study, drug side effects in patients who were followed up with a rheumatic disease and treated with parenteral administration methods were evaluated. The drug side effects in children who were followed up with a rheumatic disease and treated with parenteral treatments between 2010 and 2019 were recorded, retrospectively. All parenteral treatments are applied by a clinical nurse specialist (CNS) who is experienced in pediatric rheumatology for 10 years. Four hundred and thirteen patients were evaluated in this study. The mean age was 12.09 ± 5.05 years. Most of them were diagnosed with juvenile idiopathic arthritis (n = 317) and colchicine-resistant familial Mediterranean fever (n = 57). Among the patients, 287 was treated with methotrexate, 130 with etanercept, 90 with adalimumab, 71 with anakinra, 64 with canakinumab, 55 with tocilizumab, seven with rituximab, six with infliximab, and four with abatacept. Two of the patients had a history of drug allergy (ceftriaxone = 1, ranitidine = 1). The most common adverse reactions were as follows: nausea–vomiting in 52, rash in 11, itching in three, chest tightening in two, bruising in two, headache in two, and abdominal pain in one of the patients. Drug side effects were observed after an average of three (1–4) administrations. Antihistaminic and steroids (tocilizumab = 3, infliximab = 1, methotrexate = 1) were administered to five patients due to hypersensitivity reactions. Considering the possible side effects and preparation protocols of parenteral treatments, experienced physicians and nurses are required in the field.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dinarello CA, Simon A, van der Meer JW (2012) Treating inflammation by blocking interleukin-1 in a broad spectrum of diseases. Nat Rev Drug Discov 11:633–652

    Article  CAS  Google Scholar 

  2. Monaco C, Nanchahal J, Taylor P, Feldmann M (2015) Anti-TNF therapy: past, present and future. Int Immunol 27:55–62

    Article  CAS  Google Scholar 

  3. Kremer JM, Westhovens R, Leon M, Di Giorgio E, Alten R, Steinfeld S et al (2003) Treatment of rheumatoid arthritis by selective inhibition of T-cell activation with fusion protein CTLA4Ig. N Engl J Med 349:1907–1915

    Article  CAS  Google Scholar 

  4. Nishimoto N, Miyasaka N, Yamamoto K, Kawai S, Takeuchi T, Azuma J (2009) Long-term safety and efficacy of tocilizumab, an anti-IL-6 receptor monoclonal antibody, in monotherapy, in patients with rheumatoid arthritis (the STREAM study): evidence of safety and efficacy in a 5-year extension study. Ann Rheum Dis 68:1580–1584

    Article  CAS  Google Scholar 

  5. Chambers SA, Isenberg D (2005) Anti-B cell therapy (rituximab) in the treatment of autoimmune diseases. Lupus 14:210–214

    Article  CAS  Google Scholar 

  6. Matucci A, Nencini F, Maggi E, Vultaggio A. Hypersensitivity reactions to biologics used in rheumatology. Expert Rev Clin Immunol 2019:1–9.

  7. Ruperto N, Murray KJ, Gerloni V, Wulffraat N, de Oliveira SK, Falcini F et al (2004) A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. Arthritis Rheum 50:2191–2201

    Article  CAS  Google Scholar 

  8. Patil P, Parker RA, Rawcliffe C, Olaleye A, Moore S, Daly N et al (2014) Methotrexate-induced nausea and vomiting in adolescent and young adult patients. Clin Rheumatol 33:403–407

    Article  Google Scholar 

  9. Ferrara G, Mastrangelo G, Barone P, La Torre F, Martino S, Pappagallo G et al (2018) Methotrexate in juvenile idiopathic arthritis: advice and recommendations from the MARAJIA expert consensus meeting. Pediatr Rheumatol Online J 16:46

    Article  Google Scholar 

  10. Weiner JJ, Eudy AM, Criscione-Schreiber LG (2018) How Well do rheumatology fellows manage acute infusion reactions? A pilot curricular intervention. Arthritis Care Res (Hoboken) 70:931–937

    Article  Google Scholar 

  11. Singh JA, Wells GA, Christensen R, Tanjong Ghogomu E, Maxwell L, Macdonald JK et al (2011) Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008794.pub2

    Article  PubMed  Google Scholar 

  12. de Camargo MC, Barros BCA, Fulone I, Silva MT, Silveira M, de Camargo IA et al (2019) Adverse events in patients with rheumatoid arthritis and psoriatic arthritis receiving long-term biological agents in a real-life setting. Front Pharmacol 10:965

    Article  Google Scholar 

  13. Grillo-Lopez AJ, White CA, Varns C, Shen D, Wei A, McClure A et al (1999) Overview of the clinical development of rituximab: first monoclonal antibody approved for the treatment of lymphoma. Semin Oncol 26:66–73

    CAS  PubMed  Google Scholar 

  14. Rocchi V, Puxeddu I, Cataldo G, Del Corso I, Tavoni A, Bazzichi L et al (2014) Hypersensitivity reactions to tocilizumab: role of skin tests in diagnosis. Rheumatology (Oxford) 53:1527–1529

    Article  Google Scholar 

  15. Puxeddu I, Giori L, Rocchi V, Bazzichi L, Bombardieri S, Tavoni A et al (2012) Hypersensitivity reactions during treatment with infliximab, etanercept, and adalimumab. Ann Allergy Asthma Immunol 108:123–124

    Article  Google Scholar 

  16. Vinod SS, Reed AB, Maxwell J, Cron RQ, Stoll ML (2018) Pediatric rheumatology infusion center: report on therapeutic protocols and infusions given over 4 Years with focus on adverse events over 1 Year. Pediatr Rheumatol Online J 16:16

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

RK conceptualized and designed the study, drafted the initial manuscript, and had full access to all the data in the study; HES designed the study, conducted the data analyses, drafted the initial manuscript, and had full access to all the data in the study; AT, FÇ, and MÇ drafted the initial manuscript; NAA conceptualized and designed the study, drafted the final manuscript, and had full access to all the data in the study and all authors reviewed and revised the manuscript and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Nuray Aktay Ayaz.

Ethics declarations

Conflict of interest

None.

Ethical approval

The study was reviewed and approved by local ethical committee (Ethics approval number: KAEK/2019.01.06).

Informed consent

All these patient files were evaluated retrospectively and all patients were anonymous. When the patients admitted to the hospital, the parents/patients gave a general consent approving anonymous data use for academic purpose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koç, R., Sönmez, H.E., Çakan, M. et al. Drug reactions in children with rheumatic diseases receiving parenteral therapies: 9 years’ experience of a tertiary pediatric rheumatology center. Rheumatol Int 40, 771–776 (2020). https://doi.org/10.1007/s00296-019-04498-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-019-04498-z

Keywords

Navigation