Infliximab is a biologic, monoclonal-antibody drug.
The United States Food and Drug Administration has approved Infliximab in the following cases (with doses mentioned):
Although there is little supporting data, studies have shown that infliximab is not effective in very young patients. A study published in 2014 showed a remission rate of 36% in one year in patients younger than 7 years as compared to a remission rate of 88% in older children. The remission achieved in older children is comparable to that achieved in adults. 
It is also used off-label (not FDA-approved) to treat the following conditions:
This drug may be given in combination with methotrexate to avoid possible immunologic responses by the host which would decrease or blunt the effect of the drug.
Infliximab is a type of biologic therapy/immunotherapy designed to stimulate our body's immune system and treat certain diseases. Infliximab is a monoclonal antibody that inhibits tumor necrosis factor-alpha (TNF-a). TNF-a is a signaling protein involved in acute phase reaction and systemic inflammation. It is produced by macrophages, CD4+ lymphocytes, NK cells, neutrophils, mast cells, eosinophils, and neurons. This inhibition of TNF-a stops the cascade of the inflammatory reaction, leading to the improvement of the disease condition (psoriasis, Crohn disease, etc.). Infliximab is a chimeric protein that contains both murine and human components. In adults, it has been shown to have a half-life of 7 to 12 days.
Infliximab is administered via an intravenous route. It has been shown to cause type I and type III hypersensitivity reactions in the studies conducted.
A variety of strategies are used to prevent infliximab-induced infusion reaction, including the following:
Infliximab is a generally safe and a well-tolerated medication, but as the dose or the age of the patient (greater than 60 years) increases, there are heightened chances of side effects:
Infliximab has been shown to cross the placenta and is present in the serum of babies whose mothers were given infliximab during pregnancy for up to 6 months. CLincians have seen agranulocytosis and reactions to live vaccines in these infants. Therefore, a wait of 6 or more months is the recommendation in exposed infants before administering live vaccines.
Patients have developed antibodies (human anti-chimeric antibodies) against infliximab, which not only lowers the efficacy of the drug but also causes infusion reactions. To reduce this risk, co-administration of other immunosuppressors like methotrexate should be a consideration.
Infliximab can be administered with care in certain conditions, but the following conditions are defined as a contraindication to infliximab administration:
Use infliximab with caution in the following conditions:
It is known to cause a cross-reaction with some drugs (eg., abatacept, adalimumab, etanercept), so care is administered when the patient is on another medicine.
Before administering infliximab following tests are recommendations; patients should have testing for the following:
Tuberculosis: A thorough screening for tuberculosis (TB) is necessary with:
Hepatitis B: A negative hepatitis screen (particularly Hep B surface antigen) is required.
Heart Failure: Careful monitoring is necessary with serial echocardiograms to avoid heart failure exacerbations. Therapy should immediately discontinue if the patient has frequent or worsening heart failure exacerbations.
Others: Detailed history should be taken to evaluate the patient for any recent or active infection, any recent or upcoming surgery, or live virus vaccination. Avoid live vaccine administration should in patients taking infliximab.
Infliximab is usually administered by healthcare personnel in a medical setting. Toxicity is very rare. Therefore, there is no specific treatment for it. The best treatment if such an event occurs is supportive treatment.
Infliximab is an effective drug for a number of chronic inflammatory disorders. However, healthcare workers including the clinician and pharmacist should work together to ensure that the patient has been worked up for tuberculosis, hepatitis B, and cardiac status evaluated prior to administration of the drug. Close monitoring of the patient by a specialty trained nurse is required, as the drug does have mild to moderate adverse effects. The best outcomes will be achieved by an interprofessional approach to the use of infliximab. [Level 5]
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