Infliximab; Uses, Dosage, Side Effects, Drug Interactions

Infliximab








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Infliximab is a chimeric monoclonal antibody biologic drug that works against tumor necrosis factor alpha (TNF-α) and is used to treat autoimmune diseases. It is an antibody administered intravenously that is used for treating several chronic inflammatory diseases. Infliximab works by blocking the effects of tumor necrosis factor alpha (TNF alpha), a substance made by cells of the body which has an important role in promoting inflammation. Infliximab injection is used in adults to treat Crohn disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and chronic severe plaque psoriasis. It is also used in children to treat Crohn disease and ulcerative colitis. Infliximab injection is a monoclonal antibody that works to enhance and improve the immune system.

Infliximab works by binding to TNF-α. TNF-α is a chemical messenger (cytokine) and a key part of the autoimmune reaction. In rheumatoid arthritis, infliximab seems to work by preventing TNF-α from binding to its receptor in the cell.

Mechanism of action of Infliximab

Infliximab is aIgG1κ monoclonal antibody that binds to soluble and transmembrane forms of TNF-α with high affinity to disrupt the pro-inflammatory cascade signaling. Binding of the antibody to TNF-α prevents TNF-α from interacting with its receptors. Infliximab does not neutralize TNF-α (lymphotoxin-α), a related cytokine that utilizes the same receptors as TNF-α . Blocked actions of TNF-α further leads to downregulation of local and systemic pro-inflammatory cytokines (i.e. IL-1, IL-6), reduction of lymphocyte and leukocyte migration to sites of inflammation, induction of apoptosis of TNF-producing cells (i.e. activated monocytes and T lymphocytes), increased levels of nuclear factor-κB inhibitor, and reduction of reduction of endothelial adhesion molecules and acute phase proteins . Its inhibitory actions on TNF-α was demonstrated in human fibroblasts, endothelial cells, neutrophils, B and Tlymphocytes and epithelial cells. Infliximab also atteunates the production of tissue degrading enzymes synthesized by synoviocytes and/or chondrocytes. According to a transgenic mice study that developed polyarthritis due to constitutive levels of human TNF-α, infliximab decreased synovitis and joint erosions in collagen-induced arthritis and allows eroded joints to heal.

Indications of Infliximab

Contra-Indications of Infliximab

Dosage of Infliximab

Strengths: abda 100 mg; dyyb 100 mg; 100 mg

Rheumatoid Arthritis

  • 3 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 3 mg/kg IV every 8 weeks thereafter;
  • Adjusting the dose up to 10 mg/kg IV or treating as often as every 4 weeks may be considered for patients who have an incomplete response

Ankylosing Spondylitis

  • 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 6 weeks thereafter

Psoriatic Arthritis

  • 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks thereafter

Psoriasis

  • 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 8 weeks thereafter

Crohn’s Disease 

  • 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 8 weeks thereafter; treatment with 10 mg/kg IV may be considered for patients who respond and then lose their response

Side Effects of Infliximab

The most common

More common

Rare

Drug Interactions of Infliximab

Infliximab may interact with the following drugs, supplements, & may change the efficacy of the drug

  • adalimumab
  • bacillus Calmette-Guérin (BCG)
  • belimumab
  • canakinumab
  • certolizumab pegol
  • live vaccines (e.g., measles, mumps, and rubella (MMR), tuberculosis (BCG), yellow fever)
  • cyclophosphamide
  • denosumab
  • fingolimod
  • leflunomide
  • nivolumab
  • natalizumab
  • pimecrolimus
  • roflumilast
  • sulfasalazine
  • tacrolimus
  • tocilizumab
  • tofacitinib
  • trastuzumab
  • vaccines (e.g., yellow fever, BCG, cholera, typhoid, varicella, meningococcal, diphtheria)

Pregnancy Catagory

FDA Pregnancy Category B

Pregnancy

This medication is not recommended for use during pregnancy. Women who may become pregnant should use an effective method of birth control while they are taking this medication and for at least 6 months after the last treatment.

Lactation

It is not known if infliximab passes into breast milk. Women should not breastfeed while they are taking this medication and should not start breastfeeding until at least 6 months after the last treatment. The safety and effectiveness of this medication have not been established for children under 6 years old. It can be used to treat children 6 years and older who have moderate-to-severe ulcerative colitis. It can also be used to treat children 9 years and older who have moderate-to-severe Crohn’s disease.

References

Infliximab

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