At a glance
Infliximab is a monoclonal antibody used for the treatment of inflammatory conditions including rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease.
Indications
- Crohn's Disease (adults and pediatric)
- Ulcerative Colitis (adults and pediatric)
- Rheumatoid Arthritis (in combination with methotrexate)
- Ankylosing Spondylitis
- Psoriatic Arthritis
- Plaque Psoriasis
Pharmacology
Infliximab neutralizes biological activity of TNFα. Biological activities attributed to TNFα include: induction of pro-inflammatory cytokines (IL-1 and IL-6), enhancement of leukocyte migration by increasing endothelial layer permeability and expression of adhesion molecules, activation of neutrophil and eosinophil functional activity, induction of acute phase reactants and other liver proteins, and induction of tissue degrading enzymes produced by synoviocytes and/or chondrocytes. Cells expressing transmembrane TNFα bound by infliximab can be lysed in vitro or in vivo.
Dosage
Adult Dose (IV Infusion):
- Crohn's Disease: 5 mg/kg at 0, 2 and 6 weeks, then every 8 weeks; may increase to 10 mg/kg if loss of response
- Ulcerative Colitis: 5 mg/kg at 0, 2 and 6 weeks, then every 8 weeks
- Rheumatoid Arthritis: 3 mg/kg (with methotrexate) at 0, 2 and 6 weeks, then every 8 weeks; may increase to 10 mg/kg or every 4 weeks
- Ankylosing Spondylitis: 5 mg/kg at 0, 2 and 6 weeks, then every 6 weeks
- Psoriatic Arthritis & Plaque Psoriasis: 5 mg/kg at 0, 2 and 6 weeks, then every 8 weeks
Child Dose (IV Infusion):
- Crohn's Disease (6-17 years): 5 mg/kg at 0, 2 and 6 weeks, then every 8 weeks
- Ulcerative Colitis (6-17 years): 5 mg/kg at 0, 2 and 6 weeks, then every 8 weeks
Side effects
Most Common (>10%):
- Infections (upper respiratory, sinusitis, pharyngitis)
- Infusion-related reactions
- Headache
- Abdominal pain
Others: Fever, chills, sweating, rash, pruritus
Use in pregnancy
Use in Pregnancy: Category B; it is not known whether Infliximab can cause fetal harm or affect reproduction capacity; animal studies have shown harmful effects; doctor will weigh benefits and risks.
Pregnancy Category: B — always consult a doctor before taking during pregnancy.
Precautions & warnings
Precautions:
- Serious infections: Do not give during active infection; monitor and stop if infection becomes serious
- Invasive fungal infections: Consider empiric antifungal therapy for patients in endemic regions
- Malignancies: Incidence of malignancies including lymphoma was greater in infliximab treated patients
- Hepatitis B virus reactivation: Test for HBV before starting; monitor carriers during and after therapy
- Hepatotoxicity: Stop in cases of jaundice and/or marked liver enzyme elevations
- Heart failure: New onset or worsening symptoms may occur
- Cytopenias: Seek medical attention if signs develop; consider stopping infliximab
- Live vaccines or therapeutic infectious agents should not be given
Overdose effects
Overdose: No specific reactions known; provide symptomatic supportive treatment; seek immediate medical attention.
Storage conditions
Infliximab must be refrigerated at 2°C to 8°C; do not use beyond expiration date; contains no preservative.