Abstract
Rheumatoid arthritis (RA) patients requiring total joint arthroplasties under administration of infliximab, which may remain in donated blood if preoperative autologous blood donation (PABD) is undertaken for the surgery, may risk infection. We clarified infliximab hemokinetics in blood stored for such patients. A 20-ml blood sample was obtained from each of the ten RA patients receiving infliximab at just after administration and at 2 and 4 weeks following the administration of infliximab, mixed with 2.8 ml citrate-phosphate-dextrose-adenine (CPDA-1) and stored at 4–6°C. Plasma levels of infliximab in the stored blood were measured just after-mixture with CPDA-1, and at 2 and 4 weeks following the start of storage. Serum levels were also measured just before infliximab administration and at each phlebotomy. The plasma infliximab levels in the stored blood remained close to their original serum levels at the time of each corresponding phlebotomy, only somewhat influenced by dilution of CPDA-1, and sustained for 4 weeks following the start of storage, unlike in vivo, where levels decreased. This suggests that in order to prevent side effects, the later after infusion of infliximab the phlebotomy occurs, the better, and that the amount of stored blood transfusion should be consistent with that of blood loss.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Nishimura K, Wakimoto N, Sasahara J, Yanagisawa C, Eda F, Nishino J, et al. No change of infliximab levels in stored blood for preoperative autologous blood donation: a preliminary report. Mod Rheumatol. 2005;15:302–4.
Maini RN, Breedveld FC, Kalden JR, Smolen JS, Davis D, Macfarlane JD, et al. Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum. 1998;41:1552–63.
Markham A, Lamb HM. Infliximab: a review of its use in the management of rheumatoid arthritis. Drugs. 2000;59:1341–59.
Siegel SA, Shealy DJ, Nakada MT, Le J, Woulfe S, Probert L, et al. The mouse/human chimeric monoclonal antibody cA2 neutralizes TNF in vitro and protects transgenic mice from cachexia and TNF lethality in vivo. Cytokine. 1995;7:15–25.
Maini RN, Elliott MJ, Long-Fox A, Feldmann M, Kalden JR, Antonio C, et al. Clinical response of rheumatoid arthritis (RA) to anti-TNF alpha (cA2) monoclonal antibody (mab) is related to administered dose and persistence of circulating antibody [abstract]. Arthritis Rheum. 1995;38 Suppl:S186.
Hanauer SB. Safety of infliximab in clinical trials. Aliment Pharmacol Ther. 1999;13 Suppl 4:16–22.
Maini R, Clair EWS, Breedveld F, Furst D, Kalden J, Weisman M, et al. Infliximab (chimeric anti-tumour necrosis factor α monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant mathotrexate: a randomised phase III trial. Lancet. 1999;354:1932–9.
Lipsky PE, van der Heijde DMFM, Clair WS, Furst DE, Breedveld FC, Kalden JR, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med. 2000;30:1594–602.
Maini RN, Breedveld FC, Kalden JR, Smolen JS, Furst D, Weisman MH, et al. Sustained improvement over two years in physical function, structural damage, and signs and symptoms among patients with rheumatoid arthritis treated with infliximab and methotrexate. Arthritis Rheum. 2004;50:1051–65.
Westhovens R, Yocum D, Han J, Berman A, Strusberg I, Geusens P, et al. The safety of infliximab, combined with background treatments, among patients with rheumatoid arthritis and various comorbiditied. A large, randomized, placebo-controlled trial. Arthritis Rheum. 2006;54:1075–86.
Bibbo C, Goldberg JW. Infectious and healing complications after elective orthopaedic foot and ankle surgery during tumor necrosis factor-alpha inhibition therapy. Foot Ankle Int. 2004;25:331–5.
Wendling D, Balblanc J-C, Brousse A, Lohse A, Lehuede G, Garbuio P, et al. Surgery in patients receiving anti-tumor necrosis factor α treatment in rheumatoid arthritis: an observational study on 50 surgical procedures. Ann Rheum Dis. 2005;64:1378–9.
den Broeder AA, Creemers MCW, Fransen J, de Jong E, de Rooji DR, Wymenga A, et al. Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti tumor necrosis factor: a large retrospective study. J Rheumatol. 2007;34:689–95.
Giles JT, Bartlett SJ, Gelber AC, Nanda S, Fontaine K, Raffing V, et al. Tumor necrosis factor inhibitor therapy and risk of serious postoperative orthopedic infection in rheumatoid arhtritis. Arthritis Care Res. 2006;55:333–7.
Ledingham J, Deighton C. Update on the British society for rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis (update of previous guidelines of April 2001). Rheumatology. 2005;44:157–63.
Mochizuki T, Momohara S, Ikari K, Okamoto H, Kobayashi S, Tsukahara S, et al. The serum concentration of infliximab in cases of autologous blood donation for patients with rheumatoid arthritis. Mod Rheumatol. 2007;17:24–7.
Fujiwara T. Preclinical and clinical investigations of infliximab (Remicade®), a novel human/murine chimeric monoclonal antibody preparation raised against human TNFα (in Japanese). Jpn Pharmacol Ther. 2005;33:581–626.
Acknowledgments
We thank Fukiko Eda for her technical assistance. This study was supported by the Tanabe Seiyaku Co., LTD. The company did not influence the methods of evaluation, interpretation of the results, or the writing of the report.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Nishimura, K., Wakimoto, N., Sasahara, J. et al. No changes in infliximab levels in blood stored for preoperative autologous blood donation. Mod Rheumatol 18, 29–33 (2008). https://doi.org/10.1007/s10165-007-0008-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10165-007-0008-x