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.
Similar content being viewed by others
References
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
Monaco C, Nanchahal J, Taylor P, Feldmann M (2015) Anti-TNF therapy: past, present and future. Int Immunol 27:55–62
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
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
Chambers SA, Isenberg D (2005) Anti-B cell therapy (rituximab) in the treatment of autoimmune diseases. Lupus 14:210–214
Matucci A, Nencini F, Maggi E, Vultaggio A. Hypersensitivity reactions to biologics used in rheumatology. Expert Rev Clin Immunol 2019:1–9.
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
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
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
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
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
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
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
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
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
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
Funding
None.
Author information
Authors and Affiliations
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
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
About this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-019-04498-z