Corticosteroid premedication for infliximab remains unnecessarily common.

Cohen-Mekelburg S, Gibbs J, Wallace B, Kenney B, Waljee AK. Corticosteroid premedication for infliximab remains unnecessarily common. The American journal of managed care. 2025 Jul 1; 31(7):323-327, DOI: 10.37765/ajmc.2025.89765.

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Abstract:

OBJECTIVES: Corticosteroid use can lead to serious adverse events even with short-term use. Data suggest that corticosteroid premedication prior to infliximab (IFX) administration is ineffective at preventing infusion reactions. Therefore, we examined corticosteroid premedication practices in inflammatory bowel disease (IBD), which represent an opportunity for reducing corticosteroid overuse. STUDY DESIGN: National cohort study of patients with IBD receiving IFX using 2015-2021 Truven (now Merative) MarketScan data. METHODS: We examined corticosteroid premedication as an outcome of interest using descriptive statistics and identified associated patient-level factors using bivariate analyses. We also explored differences in corticosteroid premedication for first IFX infusions (ie, no opportunity for a prior reaction) and subsequent IFX infusions. RESULTS: We identified 19,637 patients with IBD who received IFX and met the inclusion criteria. Corticosteroid premedication use declined from 27.4% in 2015 to 20.4% in 2020. During this time, 38.7% of the 4639 patients who received IFX premedication were premedicated for more than 90% of their infusions. Overall, those who received corticosteroid premedication were younger (median age, 30 vs 33 years), more often female (51.6% vs 47.7%), and more likely to have 1 or more comorbidities (21.7% vs 18.8%) than patients who were not premedicated, but the groups had similar rates of diabetes (4.1% vs 4.2%), cataracts (1.4% vs 1.3%), and osteoporosis (1.4% for both). Among patients receiving corticosteroid premedication, 62.5% received it with their first IFX infusion, suggesting routine practice rather than a strategy for those who had a prior infusion reaction. CONCLUSIONS: Corticosteroid premedication for IFX remains unnecessarily common. Corticosteroid premedicating is a common low-value practice that could be targeted to reduce corticosteroid overuse in IBD.