Infliximab (Intranvenous)

Overview

As an artificial antibody, Infliximab is used to treat autoimmune diseases. When patients have these disease, their immune system is over active. Rather than reacting to and damaging potential harmful cells, the body damages its own tissue. As there are numerous types of autoimmune diseases, patients can be affect in different ways.

In the case of Crohn disease and ulcerative colitis, for example, T lymphocyte cells (T-cells) infiltrate the colon and/or gastrointestinal tract. As a result of the misplaced T-cells, the patient experiences inflammation which cases various symptoms, such as, severe abdominal pain, weight loss, diarrhea, rectal bleeding and/or anemia.

Similarly, in cases of rheumatoid arthritis, the immune system attacks and damages the lining of the joints. As well as causing symptoms in the affected joints, rheumatoid arthritis causes inflammation which can affect the whole body. With T-cell activation playing a role in the amplification phase of this condition, it is clear that the infiltration of T-cells into areas of the body can result in chronic inflammation.

By targeting the TNF-alpha protein in the patient's body, Infliximab can help to reduce inflammation and the symptoms it causes. As TNF-alpha plays a role in regulating the immune cells, over activity of the immune system can often be traced back to faulty TNF-alpha. When administered, Infliximab binds to TNF-alpha cells which prevents them from adhering to TNF-alpha receptors. In doing so, the inflammatory response is avoided. Defined as a monoclonal antibody, Infliximab effectively improves the function of the immune system and prevents it from attacking the body's own tissues.

Whilst autoimmune diseases are characterized by over activity of the immune system, the exact cause of this over activity depends on the nature of the patient's illness. If T-cells invade the gastrointestinal tract, for example, the patient is likely to suffer from Crohn disease. Alternatively, if T-cells infiltrate the synovial membranes of the joints, the patient may develop rheumatoid arthritis.

In order for the inflammatory response to be effective, however, TNF-alpha receptors must be engaged. By administering Infliximab, physicians can prevent the inflammatory response from occurring or reduce it considerably. As a result, patients should notice a significant reduction in their symptoms when they are being treated with Infliximab. Whilst Infliximab won't cure their autoimmune disease, it can be used to manage their condition and minimize their symptoms.

Conditions Treated

Type Of Medicine

Monoclonal antibody

Side Effects

When patients are prescribed medication, they may develop some adverse effects as a result of taking or using the drug. In some cases, the side-effects caused by a particular medication can require further treatment, whilst others may not need to be treated at all.

If patients experience any of the following side-effects during or following treatment with Infliximab, they should inform their physician immediately:

  • Stomach or abdominal pain
  • Fainting
  • Chest pain
  • Headache
  • Chills
  • Muscle pain
  • Cough
  • Nasal congestion
  • Dizziness
  • Itching, rash or hives
  • Fever
  • Runny nose
  • Flushing of the face
  • Nausea
  • Sneezing
  • Unusual weakness or tiredness
  • Sore throat
  • Vomiting
  • Tightness in the chest
  • Back pain
  • Troubled breathing
  • Cloudy or bloody urine
  • Painful or difficult urination
  • Cracks in the skin at the corners of the mouth
  • Skin rash
  • Diarrhea
  • Pain in side or back
  • Frequent urge to urinate
  • Tenderness or pain around the cheekbones and eyes
  • Irritation or soreness of the tongue or the mouth
  • Redness or soreness around the toenails or fingernails
  • White patches on the tongue or in the mouth
  • Vaginal itching or burning and discharge
  • Joint or bone pain
  • Abscess (area of infection containing pus)
  • Feeling of fullness
  • Tarry, black stools
  • Hernia
  • Blood in the stools or urine
  • Red, pinpoint spots on the skin
  • Constipation
  • Hernia
  • Pounding or irregular heartbeat
  • Unusual weight loss
  • Pain in the rectum
  • Stomach pain (severe)
  • Pain spreading from the stomach or abdomen to the left shoulder
  • Tendon injury
  • Painful or swollen glands
  • Unusual bruising or bleeding
  • Area rash
  • Yellowing of the skin or eyes
  • Bloody nose
  • Numbness, tingling, burning or pain in the arms, feet, legs or hands
  • Difficulty with speaking
  • Change in mental status
  • Bloody or dark urine
  • Fast heartbeat
  • Clay-colored stools
  • General feeling of weakness or tiredness
  • Continuing vomiting
  • Heavier menstrual periods
  • Convulsions
  • Hoarseness
  • Difficulty with swallowing
  • Loss of appetite
  • Inability to move the legs and arms
  • Pale skin
  • Swelling, puffiness or itching around the eyes or of the eyelids, lips, tongue or face Light-colored stools
  • Noisy breathing
  • Severe stomach or abdominal pain
  • Loss of bladder control
  • Sore, red or itching skin
  • Muscle spasm or jerking of all extremities
  • Severe muscle weakness, progressing and sudden
  • Red, crusted or scaling skin
  • Painless swelling in the armpits, groin or neck
  • Seizures
  • Unpleasant breath odor
  • Sensation of pins and needles
  • Irregular or slow breathing
  • Sudden loss of consciousness
  • Blisters, welts or sores
  • Stabbing pain
  • Upper right stomach pain
  • Sudden weakness and numbness in the legs and arms
  • Vomiting of blood

Similarly, patients should obtain medical assistance if they experience any other side-effects whilst they are being treated with Infliximab.

Dosage

When patients are prescribed Infliximab, their dose will depend on their condition, medical history, age and weight. There are, however, standard dosing strategies for treatment with Infliximab.

If adult patients are being treated for ulcerative colitis or Crohn disease, for example, they are likely to be given 5mg of Infliximab per kilogram of bodyweight. This does will be administered three times, with a break of two weeks and four weeks between the second and third doses. Following this, a maintenance dose of 5mg per kilogram of bodyweight may be given every eight weeks. Pediatric patients over the age of six years may also be treated in accordance with this dosing strategy. If adult patients are being treated for Crohn disease, their maintenance dose may be increased to 10mg per kilogram of bodyweight, if necessary.

In most cases, patients will begin to responds to treatment within fourteen weeks of being given Infliximab. If the patient's symptoms have not improved within this timeframe, treatment with Infliximab may be discontinued and an alternative form of symptom management may be sought.

When adult patients are treated for rheumatoid arthritis, however, they are likely to be given 3mg of Infliximab per kilogram of bodyweight. This dose should be administered three time, with a break of two and four weeks between the second and third doses. Subsequently, the patient may be given a maintenance dose of 3mg per kilogram of bodyweight every eight weeks. However, if the patient's symptoms persists, the maintenance dose may be given every four weeks or increased up to 10mg per kilogram of bodyweight.

If adult patients are given Infliximab for the treatment of psoriatic arthritis, their initial treatments will also take place across a period of six weeks. 5mg of Infliximab per kilogram of bodyweight should be administered three times, with a break of two and four weeks between the second and third doses. Following this, a maintenance dose of 5mg per kilogram of bodyweight may be given every eight weeks.

When Infliximab is used to treat rheumatoid arthritis and/or psoriatic arthritis, the drug is usually given in conjunction with Methotrexate and this may affect the patient's dose.

Similarly, if patients are treated for ankylosing spondylitis or psoriasis, the usual treatment is 5mg of Infliximab per kilogram of bodyweight over three doses, with two and four weeks between the second and third doses. A maintenance dose of 5mg per kilogram of bodyweight can be given every eight weeks following the initial treatment.

As Infliximab is administered via an intravenous infusion, patients will be given this medicine in a clinical setting, such as a hospital. They will not, therefore, have to calculate their own dose of Infliximab or administer the medicine. As Infliximab must be given in accordance with the treatment schedule, patients should contact their physician in advance if they think they will be unable to be present for any treatments.

Potential Drug Interactions:

As some medications can interact with one another, they may not be prescribed at the same time. If patients are being treated with Infliximab, for example, they will not usually be prescribed the following medicines:

  • Abatacept
  • Tacrolimus
  • Adenovirus Vaccine Type 4, Live
  • Influenza Virus Vaccine, Live
  • Adenovirus Vaccine Type 7, Live
  • Measles Virus Vaccine, Live
  • Anakinra
  • Mumps Virus Vaccine, Live
  • Bacillus of Calmette and Guerin
  • Rotavirus Vaccine, Live
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Tocilizumab
  • Cyclosporine
  • Rubella Virus Vaccine, Live
  • Fosphenytoin
  • Smallpox Vaccine
  • Paclitaxel
  • Sirolimus
  • Phenytoin
  • Typhoid Vaccine
  • Poliovirus Vaccine, Live
  • Varicella Virus Vaccine
  • Quinidine
  • Warfarin
  • Rilonacept
  • Yellow Fever Vaccine

Similarly, interactions can occur between prescribed medicines and over-the-counter drugs, vitamins and/or supplements. Due to this, patients should tell their physician if they are using any of these substances before they begin receiving treatment with Infliximab. Patients should also obtain medical advice before using any new over-the-counter medicines, supplements or vitamins once they have begun treatment with Infliximab.

Warnings

Before patients are given Infliximab, they should discuss their current health and medical history with their doctor. There are some conditions which may affect the patient's treatment with this medication and these can include:

Pediatric patients with Crohn disease or ulcerative colitis can be treated with Infliximab injections. However, the use of this medicine has not been tested on patients under the age of six years. Infliximab has not been shown to be effective in the treatment of juvenile arthritis and is not, therefore, used to treat this condition. Similarly, the effects of Infliximab in treating pediatric patients with plaque-psoriasis are unknown and this medicine is not usually prescribed for this purpose.

During or following treatment, patients may develop an infusion reaction. They should notify their nurse or physician if they experience any of the following symptoms:

  • Fever
  • Chills
  • Chest pain
  • Itching
  • Fainting
  • Dizziness
  • Rash
  • Hives
  • Headache
  • Lightheadedness
  • Joint pain
  • Trouble breathing
  • Difficulty swallowing
  • Swelling of the tongue, throat or face
  • Shortness of breath

Whilst patients are being treated with Infliximab, their body's ability to fight infection can be compromised. If patients experience unusual weakness or tiredness, fever, cough, chills or other flu-like symptoms, they should obtain immediate medical treatment.

Infliximab can cause patients to experience serious skin reactions. If patients develop the following symptoms, they should obtain immediate medical treatment:

  • Loosening, peeling or blistering of the skin
  • Cough
  • Fever
  • Diarrhea
  • Itching
  • Chills
  • Muscle or joint pain
  • White spots, ulcers or sores in the mouth
  • Red skin lesions
  • Sore throat
  • Unusual weakness or tiredness

Being treated with Infliximab can increase the patient's risk of suffering autoimmune hepatitis or a lupus-like syndrome. Due to this, patients must obtain urgent medical treatment if they experience the following symptoms:

  • Nausea
  • Vomiting
  • Light colored stools
  • General feeling of illness, weakness or discomfort
  • Fever
  • Chills
  • Dark brown urine
  • Joint pain
  • Rash on the arms or the cheeks which is worse in the sun
  • Yellowing of the eyes or the skin
  • Upper right sided stomach pain
  • Severe tiredness

A relatively small number of patients using Infliximab have developed cancer. This may be more likely if the patient smokes, has an existing lung disease or has received long-term phototherapy treatment. However, some teenagers and children with ulcerative colitis or Crohn disease have developed hepatosplenic T-cell lymphoma after being treated with Infliximab. Patients should discuss this risk with their doctor before beginning treatment. If patients are using Infliximab and experience any of the following symptoms, they must seek medical assistance straight away:

  • Unusual weakness, bruising or bleeding
  • Unexplained weight loss
  • Swollen lymph nodes in the groin, armpit or neck
  • Scaly, red patches
  • Raised bumps with pus on the skin

Treatment with Infliximab can also increase the patient's risk of developing skin cancer. Patients should consult their doctor if they experience any skin changes or new growths.

Patients should not have any immunizations without their doctors express approval if they are being treated with Infliximab. Before being given Infliximab, pediatric patients should have up-to-date vaccinations.

Before being given Infliximab, patients will be tested for tuberculosis. Patients should inform their doctor if anyone in their home has ever had a positive reaction to the tuberculosis skin test.

When patients are being treated with Infliximab, they should have their heart checked at regular intervals. Patients should also seek immediate medical help if they experience the following symptoms:

  • Sudden weight gain

  • Swelling in the feet and ankles

  • Shortness of breath

Although Infliximab is not thought to pose a risk of pregnant patients, this cannot be ruled out. If patients are pregnant, they should discuss the potential risks with their physician before beginning treatment.

If patients become pregnant whilst receiving Infliximab, they should notify their doctor immediately. The baby's doctor must also be told that the mother was undergoing treatment with Infliximab as the baby's vaccinations may need to be delayed following the birth.

It is not known if Infliximab can be transferred to an infant via breastfeeding. Patients are, therefore, advised not to breastfeed if they are being treated with Infliximab and should obtain medical advice if they are considering doing so.

In rare cases, patients may develop an allergic reaction whilst being treated with Infliximab. If so, they will require emergency medical treatment. An allergic reaction may involve the following symptoms:

  • Difficulty breathing
  • Hives
  • Welts
  • Itching
  • Difficulty swallowing
  • Shortness of breath
  • Swelling of the face, lips, tongue, throat, mouth or hands

Storage

Normally stored in single-use vials, Infliximab can normally be kept at a refrigerated temperature between 2-8C (36-46F) or at a room temperature of up to 30C (86F). However, Infliximab vials should not be returned to the refrigerator once they have been stored at room temperature. Infliximab can typically be stored for six months, providing the expiration date is still valid.

As Infliximab is administered in a clinical setting, patients should not need to store this medicine at home.

Summary

Although there are some risks associated with the use of Infliximab, it can be an effective treatment for many patients. Providing patients are thoroughly assessed prior to treatment and monitored throughout, the risk of complications occurring can be somewhat reduced.

Despite the potential complications caused by this treatment, Infliximab provides symptoms relief for numerous patients. As autoimmune diseases can cause systemic inflammation and a range of debilitating symptoms, treatment with Infliximab is extremely beneficial for a considerable number of patients.