Infliximab
๐ Key Point: Infliximab neutralises TNF-alpha, reducing inflammatory activity.
โ ๏ธ Always exclude Tuberculosis and serious infections before starting therapy.
๐ About
- Infliximab is a chimeric monoclonal antibody (โ75% human, 25% mouse) targeting TNF-ฮฑ.
- Cost: ~ยฃ10,070.88 in year 1; ~ยฃ8,812.02 annually thereafter (NHS data).
- Binds both soluble and membrane-bound TNF-ฮฑ, reducing inflammation and inducing apoptosis of activated lymphocytes.
๐ฏ Indications
- ๐งโโ๏ธ Crohnโs disease: Induction and maintenance of remission; useful in fistulising disease.
- ๐งโโ๏ธ Ulcerative colitis: Severe pancolitis not responding to standard therapy.
- ๐งโโ๏ธ Rheumatoid arthritis: After inadequate response to โฅ2 DMARDs (incl. methotrexate).
๐งพ Pre-Treatment Checks
- ๐ Full TB history (travel, family, occupational risk).
- ๐ซ Chest X-ray and referral to local TB service for Mantoux/IGRA screening.
- ๐งช Viral screening: HIV, Hepatitis B & C, VZV, HSV.
- ๐ Baseline tests: FBC, U&E, LFTs, ESR, CRP.
- ๐ Repeat bloods prior to each infusion during nursing assessment.
๐ Dose
- Standard: 3 mg/kg IV infusion at weeks 0, 2, 6, then every 8 weeks.
- ๐ If inadequate response: escalate by 1.5 mg/kg increments up to 7.5 mg/kg q8w, or shorten interval to q4w.
- Always given in specialist centres with monitoring for infusion reactions.
โ Contraindications
- ๐ซ Active infection or sepsis, untreated abscess.
- ๐ซ Active or latent TB.
- ๐ซ Moderateโsevere heart failure.
- ๐ซ Hypersensitivity to infliximab.
- ๐ซ Avoid in pregnancy & breastfeeding unless specialist advice.
๐ข Side Effects
- โ ๏ธ Antibody development โ infusion reactions & flu-like illness.
- ๐ค Viral infections, URTI, sinusitis, abdominal pain, nausea, headache.
- ๐ซ Reactivation of TB or opportunistic infections.
- โค๏ธ Cardiac events, demyelination.
- ๐งฌ Risk of lymphoma and other malignancies (rare).
๐ References
