What is Infliximab?

Why is Infliximab prescribed?

What are the possible side-effects?

What are the risks?

What else should I know about Infliximab?

What is Infliximab?

Infliximab (trade names Remicade, Inflectra, Remsima) is an anti-TNF (anti-tumour necrosis factor) drug. TNF is a protein which is found in everyone’s blood as part of the body’s normal response to infection. However, in rheumatoid arthritis and some other inflammatory diseases abnormal production of TNF causes inflammation and damage to bones, cartilage and tissue. Anti-TNF drugs block the action of TNF and so reduce this inflammation.

What type of drug is infliximab (trade names Remicade, Inflectra, Remsima)?

Infliximab is an anti-TNF (anti-tumour necrosis factor) drug.

What does it do?

It blocks the action of TNF proteins and so reduces inflammation.

What is it used for?

It is used to treat rheumatoid arthritis and psoriatic arthritis. It is also used in inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and can help with the arthritis with this condition.

Occasionally it is used in severe ankylosing spondylitis.

How is it taken?

It is given as an infusion (drip) in hospital, usually every eight weeks once treatment has been established.

Are there any side-effects?

Side-effects include a blocked or runny nose, headache, dizziness, flushing, low blood pressure, a rash, itch, chest tightness, shortness of breath, low or high blood pressure, fevers, stomach pain or indigestion. You may be given some medications (like steroids or anti-histamines) to prevent these symptoms.   Infliximab can also make you more likely to develop infections.

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Why is Infliximab prescribed?

Infliximab is available for people with rheumatoid arthritis and psoriatic arthritis, and sometimes for psoriasis, inflammatory bowel disease or severe ankylosing spondylitis.

Infliximab will only be prescribed if your arthritis is active. If you have rheumatoid arthritis it will only be used if you have already tried methotrexate and another disease-modifying anti-inflammatory drug (DMARD) such as sulfasalazine or hydroxychloroquine, or if you cannot use these drugs for any reason. In most cases methotrexate will be continued alongside infliximab. Slightly different conditions may apply in the case of the other diseases.

Is there any reason I will not be prescribed infliximab?

Infliximab will not be prescribed if:

  • your arthritis is not active
  • you have an infection.

Your doctor may decide not to prescribe infliximab if:

  • you have had tuberculosis (TB) in the past
  • you have had other repeated infections
  • you have multiple sclerosis (MS)
  • you have had cancer
  • you have or have had a serious heart condition
  • you have lung fibrosis (scarring of the lung tissue)
  • you are pregnant or breastfeeding.

When and how do I take infliximab?

Infliximab is only available on prescription from a consultant rheumatologist. Infliximab is given by intravenous infusion (drip) into your arm. It is usually done in hospital, but after you have been established on the treatment this may be done at home.

The infusion is given over two hours (this may change to one hour later on in treatment) and you will have to wait for another 1–2 hours afterwards before you can go home in case you develop any side-effects. After the first infusion you will have another one two weeks later and then one four weeks after that. After the third infusion you will continue to have one every eight weeks.

How long does infliximab take to work?

If you respond to infliximab, you will probably feel better in 2–12 weeks.

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What are the possible side-effects?

Infliximab may cause a blocked or runny nose, headache, dizziness, flushing, a rash, stomach pain or indigestion.

Infliximab affects the immune system (the body’s own defence system), so you are more at risk of infection. Rarely, your body may fail to produce enough of the blood cells that help fight infections or help you to stop bleeding. You should tell your doctor or rheumatology nurse straight away if you develop any of the following after starting infliximab:

  • a sore throat
  • a fever
  • any other symptoms of infection (like fevers, cough, shortness of breath or pain on passing urine)
  • unexplained bruising, bleeding or paleness
  • any other new symptoms or anything else that concerns you.

What should I look out for?

You should see your doctor immediately if:

  • any of the symptoms listed above are severe
  • you have not had chickenpox and you come into contact with someone who has chickenpox or shingles
  • you develop chickenpox or shingles.

Chickenpox and shingles can be severe if you are on infliximab. You may need antiviral treatment, which your doctor will be able to prescribe. Your infliximab will be stopped if you do develop chickenpox or shingles and restarted when you are better.

Very rarely, people may experience a severe allergic reaction to this drug. The symptoms can include chest tightness, breathing difficulties, a rash, swelling of the face or tongue, and a drop in blood pressure. This may come some time after receiving the medication. If this happens, urgent medical attention is required. If the reaction is severe, then treatment cannot be continued.

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

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What are the risks?

Anti-TNF drugs have been linked with some types of skin cancer – these can be readily treated when diagnosed early. Make sure you use suitable protective sun cream when you’re out in the sun, and see your doctor promptly if you notice any changes in your skin. Research so far hasn’t shown an increased risk of other cancers.

Very rarely, people taking infliximab may develop a condition called drug-induced lupus. Symptoms include a rash, fever and increased joint pain. If you develop these symptoms you should contact your specialist team. This condition is generally mild and usually clears up if infliximab is stopped

How can I reduce the risk of infection?

Because of its effects on the immune system, infliximab may make you more likely to pick up infections. You should try to avoid close contact with people who have severe active infections, and visit the Food Safety Authority of Ireland website www.fsai.ie for information on reducing your risk of infection from foods. 

Will it affect vaccinations?

If you are on infliximab it is recommended that you avoid live vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella vaccination in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the vaccination with you.

If you are in your 70s and are offered shingles vaccination (Zostavax) you should discuss this with your rheumatology team. You may be able to have the shingles vaccine before you start infliximab. Shingles vaccination is not recommended for people who are already on infliximab.

Pneumovax (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines do not interact with infliximab and are recommended.

Can I drink alcohol while on infliximab?

You can drink alcohol while on infliximab but should not exceed recommended amounts (1–2 units per day for women and 2–3 units per day for men), though your doctor may advise lower limits (e.g. 4 units per week for men and women) if you have psoriasis and/or you are also taking methotrexate. This is because methotrexate and alcohol can interact and damage your liver. Alcohol can also worsen psoriasis.

Does infliximab affect fertility or pregnancy?

If you are thinking of having a baby or if you become pregnant, you should discuss this with your rheumatologist. At present there is limited information on the use of infliximab during pregnancy and on how it might affect an unborn baby. Similarly, the effects of infliximab on men trying to father a child are uncertain.

Generally it is recommended that men and women use contraception while on this drug. However, some women have used infliximab successfully during pregnancy and guidelines may change as more evidence becomes available.

There may be an increased risk of infections in babies born to mothers using infliximab, particularly if it is taken during the second and third trimester of pregnancy. If this medication is required during these periods, you will be advised to delay the live vaccination schedule for your baby until they are 7 months old.

If you are also taking methotrexate this drug should be stopped three months before you try for a baby.

Does it affect breastfeeding?

Generally, it is recommended that you do not breastfeed if you want to re-start infliximab after pregnancy. However, limited information has shown that only small amounts of infliximab may pass into your breast milk, so you should discuss whether to take infliximab whilst breastfeeding with your doctor.

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What else should I know about Infliximab?

It is recommended that you carry a biological therapy alert card, which you can get from your doctor or rheumatology nurse. Then if you become unwell, anyone treating you will know that you are on infliximab and that you are therefore at risk of its side-effects, including infections.

If you have an interruption in your infliximab treatment of more than 16 weeks, there is an increased risk of an allergic reaction when you start the treatment again. Your doctor or infusion nurse will monitor you more closely when you restart the treatment.

Are there any alternatives to infliximab?

A number of other drugs are used in the treatment of rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease and related conditions. Your doctor or rheumatology nurse will discuss these other options with you.

Will I need any special checks while on infliximab?

You will have a chest x-ray and blood tests and screening to check whether you have ever been exposed to tuberculosis (TB) or hepatitis. Some patients may need a course of treatment for latent (asymptomatic) TB before starting infliximab. You may also have further blood tests while you are on infliximab to monitor its effects.

Infliximab may increase the risk of a hepatitis infection being reactivated if you carry the virus. If your doctor thinks that you may be at risk from a previous hepatitis infection, they may test your blood for the presence of the virus.

Can I take other medicines alongside infliximab?

Most people who are on infliximab will also be prescribed methotrexate. You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are on infliximab.

You should also be aware of the following points:

  • Infliximab is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as infliximab, unless your doctor advises otherwise. If infliximab works for you, you may be able to reduce your NSAIDs or painkillers after a time.
  • Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse specialist or pharmacist.

Can I continue with infliximab if I am going to have an operation?

If you are going to have an operation please discuss this with your doctor. Depending on the type of surgery, you may be advised to stop infliximab temporarily before surgery and until your wound has healed.

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