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- What is infliximab, and how does it work (mechanism of action)?
- What are the uses for infliximab?
- What are the side effects of infliximab?
- What is the dosage for infliximab?
- Which drugs or supplements interact with infliximab?
- Is infliximab safe to take if I'm pregnant or breastfeeding?
- What else should I know about infliximab?
What is infliximab, and how does it work (mechanism of action)?
Infliximab is an antibody administered intravenously that is used for treating several chronic inflammatory diseases. Infliximab works by blocking the effects of tumor necrosis factor alpha (TNF alpha), a substance made by cells of the body which has an important role in promoting inflammation. There are two other injectable drugs that block TNF alpha--adalimumab (Humira) and etanercept (Enbrel). Specifically, infliximab is used for treating the inflammation of
By blocking the action of TNF-alpha, infliximab reduces the signs and symptoms of inflammation. Infliximab does not cure Crohn's disease, psoriatic arthritis, or rheumatoid arthritis. Infliximab can retard the destruction of joints by rheumatoid arthritis. The FDA approved infliximab in August 1998.
What brand names are available for infliximab?
Is infliximab available as a generic drug?
Do I need a prescription for infliximab?
What are the uses for infliximab?
Infliximab is used for reducing the signs and symptoms of inflammation in moderate to severe Crohn's disease and Crohn's disease in which there are fistulas (passageways created when the inflammation penetrates beyond the wall of the intestine).
It also is approved for the treatment of active psoriatic arthritis. Infliximab is helpful in reducing the joint inflammation of juvenile rheumatoid arthritis, ankylosing spondylitis, plaque psoriasis, and psoriatic arthritis.
Infliximab is approved for use in pediatric patients with moderately to severely active Crohn's disease who have had an inadequate response to conventional therapy.
What are the side effects of infliximab?
Infliximab should be discontinued if serious reactions occur. Serious infections have been reported with other drugs that block TNF- alpha, and infections have been reported during treatment with infliximab. Therefore, infliximab should not be used in patients with serious infections. Moreover, infliximab should be discontinued if a serious infection develops during treatment. Testing for tuberculosis (PPD tests for TB) should be doneprior to treatment with infliximab because of reports of reactivation of tuberculosis in patients taking infliximab. Such patients should be treated for tuberculosis.
Decreased white and red blood cell and decreased platelet counts have been reported with infliximab. Vasculitis (inflammation of the arteries) also has been reported.
Patients with Crohn's disease or rheumatoid arthritis, particularly patients with highly active disease and/or chronic exposure to immunosuppressant therapies, may be at a higher risk (up to several fold) than the general population for the development of malignant lymphoma. More malignancies have been observed in open-label, uncontrolled clinical studies at a rate several-fold higher than expected in the general population. In controlled studies of TNF-alpha blocking agents, including infliximab, more cases of lymphoma and other malignancies have been observed among patients receiving the agents than among control group patients.
Common side effects
The most common side effects of infliximab include:
- upper respiratory tract infections,
- urinary tract infections,
- back pain,
- abdominal pain,
- weakness and
Other important side effects include:
Reactions listed above could indicate an allergy to the infliximab. They are more common among patients who develop antibodies to infliximab and are less likely to occur in patients who are taking drugs that suppress the immune system, such as methotrexate.
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What is the dosage for infliximab?
Infliximab is administered intravenously. The recommended dose is a 5 mg/kg infusion at 0, 2, and 6 weeks and then 5 mg/kg every 8 weeks for moderate to severe active Crohn's disease or fistulizing Crohn's disease in adult or pediatric patients. Adults who initially responded then lost response may be treated with 10 mg/kg.
The recommended dose for the treatment of moderately to severely active rheumatoid arthritis is 3 mg/kg at 0, 2, and 6 weeks followed by 3 mg/kg every 8 weeks. Infliximab should be combined with methotrexate. If response is incomplete, up to 10 mg/kg or treating every 4 weeks may be tried.
Ankylosing spondylitis is treated with a 5 mg/kg infusion at 0, 2, and 6 weeks then 5 mg/kg every 6 weeks.
Which drugs or supplements interact with infliximab?
Because infliximab may reduce the response of the immune system, it should not be administered with vaccines containing live bacteria or viruses. Combining infliximab with anakinra (Kineret), abatacept (Orencia) or tocilizumab (Actemra), drugs that also reduce the response of the immune system, may increase the risk of serious infections.
Is infliximab safe to take if I'm pregnant or breastfeeding?
Use of infliximab in pregnant women has not been adequately evaluated.
What else should I know about infliximab?
What preparations of infliximab are available?
Powder for intravenous injection, 100 mg
How should I keep infliximab stored?
Infliximab should be refrigerated at 2 C - 8 C (36 F - 46 F)
Infliximab (Remicade) is a drug prescribed for inflammation of Crohn's disease, rheumatoid arthritis, psoriasis, ankylosing spondylitis, and psoriatic arthritis. Side effects, dosing, drug interactions, and pregnancy safety should be reviewed prior to taking this medication.
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Related Disease Conditions
Juvenile Rheumatoid Arthritis (JRA)
Juvenile rheumatoid arthritis (JRA) annually affects one child in every thousand. There are six types of JRA. Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Osteoarthritis vs. Rheumatoid Arthritis
Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic joint disorders. RA is also an autoimmune disease. OA and RA symptoms and signs include joint pain, warmth, and tenderness. Over-the-counter pain relievers treat both diseases. There are several prescription medications that treat RA.
Non-Radiographic Axial Spondyloarthritis (nr-axSpA)
Non-radiographic spondyloarthritis (nr-axSpA) is an inflammatory arthritis that mainly affects the joints of the spine. Morning stiffness and back pain are the usual symptoms of nr-axSpA. Nonsteroidal anti-inflammatory drugs, exercise, and biologics are treatments for nr-axSpA.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. The 16 characteristic early RA signs and symptoms include the following. Anemia Both sides of the body affected (symmetric) Depression Fatigue Fever Joint deformity Joint pain Joint redness Joint stiffness Joint swelling Joint tenderness Joint warmth Limping Loss of joint function Loss of joint range of motion Many joints affected (polyarthritis)
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms and signs include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves anti-inflammatory medications and exercise.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited. Treatment incorporates medications, physical therapy, and exercise.
Arthritis (Joint Inflammation)
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout, and pseudogout.
Kawasaki disease is a rare children's disease characterized by a fever that lasts more than five days and at least four of the following five symptoms are present: rash, swollen neck lymph gland, red tongue, swelling or redness of the hands or feet, and conjunctivitis. High doses of aspirin are used to treat Kawasaki disease. Cortisone and anti-inflammatory drugs may also be used during treatment.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Scleritis is inflammation of the white part of the eye. It may be caused by a serious underlying condition, such as an autoimmune disease. Symptoms include redness, pain, tearing, sensitivity to light, and decreased visual acuity. Treatment may include eye drops as well as treatment for any underlying disease process. Scleritis cannot be prevented.
Crohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.
Scalp Psoriasis (Psoriasis of the Scalp)
Scalp psoriasis causes red, raised, scaly patches that may extend from the scalp to the forehead and the back of the neck and ears. Symptoms and signs include itching, hair loss, flaking, silvery scales, and red plaques. Treatment includes topical medicated shampoos, creams, gels, oils, ointments, and soaps, medications, and light therapy.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal anti-inflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
Inflammatory Bowel Disease (Intestinal Problems of IBD)
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), and cortisone medications.
Graft Versus Host Disease (GVHD)
Graft versus host disease (GVHD) is a condition that happens when immune cells from transplanted donor tissue attack the recipient's tissues. Signs and symptoms of acute GVHD include enteritis, hepatitis, and dermatitis. Chronic GVHD symptoms and signs include rash, skin discoloration, dry mouth or eyes, jaundice, fatigue, and wheezing, among others. The standard of GVHD treatment is immunosuppressant medications.
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