What is Infliximab (Remicade)?

Infliximab is part of a class of drugs called biologics. It acts as an immunosuppressant drug, and is commonly used to treat autoimmune diseases like:

• Ankylosing spondylitis
• Crohn’s disease
• Rheumatoid arthritis
• Ulcerative colitis
• Psoriasis
• Psoriatic arthritis

Infliximab inhibits a chemical called tumor necrosis factor (TNF)-alpha. This chemical is responsible for triggering inflammation at various sites in the body. It is administered by very slow intravenous injection, in hospital. It is used to treat these diseases if patients do not respond to other treatments, or do not tolerate them.

Complications may arise with the use of infliximab. They include:

• Allergic reactions, both immediate and delayed (3-12 days after injection).
• Serious life-threatening infections, viral, bacterial or fungal, which flare up as a result of the suppression of the natural inflammatory reaction to intruders.
• Interactions with medications such as theophylline, or warfarin.
• Worsening of congestive heart failure.
• Hepatitis
• Optic neuritis
• Seizures and other nervous system complications.
• Bone marrow suppression.
• Lupus-like syndrome.
• Psoriasis – worsening of existing psoriasis, or development of new disease.

Like any medication, infliximab may cause adverse effects, such as:

• Nausea
• Heartburn
• Abdominal pain
• Headache
• Nasal discharge
• Yeast infection
• Higher risk of some cancers, such as lymphomas and skin cancers

Some patients are more prone to developing infection while on infliximab therapy. Risk factors for infective complications with infliximab include:

• Age over 65.
• Pre-existing infection of any kind.
• Cuts or wounds in the skin.
• Diabetes
• Immunosuppressive drugs.
• Tuberculosis infection, or contact with a tuberculous patient.
• Presence or history of hepatitis B.
• Other biologic medications used to treat the same kind of conditions as infliximab.
• Vaccination with live viruses while on treatment - viral infection.

Risk factors for other complications while on this drug may include:

• Phototherapy in the past – higher risk of skin cancer.
• History of nervous system illness, such as seizures, Guillain-Barre syndrome – may precipitate nervous system complications.

To minimize the risk of adverse reactions and complications, people on infliximab should take precautions, such as:

• Avoid people with apparent infections.
• Avoid pregnancy for at least 6 months after stopping treatment.
• Avoid breastfeeding while on treatment.
• Avoid alcohol abuse.
• Avoid all foods which are not well-cooked, such as Brie cheese or unpasteurized milk.
• Inform all caregivers that you use infliximab, before any prescription or any procedure.
• Inform your caregiver of all medications you are on before you start infliximab.

References

• https://www.nlm.nih.gov/medlineplus/druginfo/meds/a604023.html
• http://www.fda.gov/downloads/Drugs/DrugSafety/ucm089023.pdf
• http://www.royalberkshire.nhs.uk/patient-information-leaflets/infliximab-October%202014.htm