Makindo Medical Notes

💉 Key Point: Infliximab neutralises TNF-alpha, reducing inflammatory activity. ⚠️ Always exclude Tuberculosis and serious infections before starting therapy.

📖 About

• Infliximab is a chimeric monoclonal antibody (≈75% human, 25% mouse) targeting TNF-α.
• Cost: ~£10,070.88 in year 1; ~£8,812.02 annually thereafter (NHS data).
• Binds both soluble and membrane-bound TNF-α, reducing inflammation and inducing apoptosis of activated lymphocytes.

🎯 Indications

• 🧑‍⚕️ Crohn’s disease: Induction and maintenance of remission; useful in fistulising disease.
• 🧑‍⚕️ Ulcerative colitis: Severe pancolitis not responding to standard therapy.
• 🧑‍⚕️ Rheumatoid arthritis: After inadequate response to ≥2 DMARDs (incl. methotrexate).

🧾 Pre-Treatment Checks

• 📋 Full TB history (travel, family, occupational risk).
• 🫁 Chest X-ray and referral to local TB service for Mantoux/IGRA screening.
• 🧪 Viral screening: HIV, Hepatitis B & C, VZV, HSV.
• 📊 Baseline tests: FBC, U&E, LFTs, ESR, CRP.
• 🔄 Repeat bloods prior to each infusion during nursing assessment.

💊 Dose

• Standard: 3 mg/kg IV infusion at weeks 0, 2, 6, then every 8 weeks.
• 📈 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.

⛔ Contraindications

• 🚫 Active infection or sepsis, untreated abscess.
• 🚫 Active or latent TB.
• 🚫 Moderate–severe heart failure.
• 🚫 Hypersensitivity to infliximab.
• 🚫 Avoid in pregnancy & breastfeeding unless specialist advice.

💢 Side Effects

• ⚠️ Antibody development → infusion reactions & flu-like illness.
• 🤒 Viral infections, URTI, sinusitis, abdominal pain, nausea, headache.
• 🫁 Reactivation of TB or opportunistic infections.
• ❤️ Cardiac events, demyelination.
• 🧬 Risk of lymphoma and other malignancies (rare).

📚 References

• SmPC – Infliximab
• NICE TA375: Biologics in Rheumatoid Arthritis