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Indications for Infliximab
- adult patients and pediatric patients (ages six years and older) with moderately to severely active Crohn’s disease who have had an inadequate response to conventional therapy;
- adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy;
- patients with moderately to severely active rheumatoid arthritis in combination with methotrexate;
- patients with active ankylosing spondylitis (arthritis of the spine);
- patients with active psoriatic arthritis;
- adult patients with chronic severe plaque psoriasis.
Information about Infliximab
Infliximab is a monoclonal antibody to human tumor necrosis factor alpha (TNFα) which has potent antiinflammatory activity and is used in the therapy of severe inflammatory bowel disease and rheumatoid arthritis.
Mechanism of action of Infliximab
Infliximab (in flix' i mab) is a mouse-human chimeric monoclonal antibody to TNFα which binds avidly to serum and tissue bound TNFα, causing its inactivation and degradation. Inhibition of TNFα activity leads to modulation of the inflammatory and pain pathways activated by this cytokine.
FDA approval information for Infliximab
Infliximab was approved for use in the United States in 1998 and current indications include rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and severe psoriasis, Crohn disease (adult and pediatric) and ulcerative colitis. Infliximab is considered a disease modifying antirheumatic drug (DMARD) and has been shown to improve symptoms as well as joint and cartilage damage in the inflammatory arthritides.
Dosage and administration for Infliximab
Infliximab is available in vials containing 100 mg under the brand name of Remicade. The dose of infliximab varies by indication (50 to 200 mg per intravenous infusion) and it is generally given at 1, 2 and 6 weeks, and then in a maintenance dose at 8 week intervals.
Side effects of Infliximab
Common side effects include rash and fever. Rare but potentially severe side effects include seizures, heart failure, renal failure, bone marrow suppression, hypersensitivity reactions and Stevens Johnson syndrome. TNFα antagonists are also capable of causing immune suppression, resulting in reactivation of microbial infections including tuberculosis and hepatitis B.
Liver safety of Infliximab
Infliximab has been linked to many instances of idiosyncratic acute liver injury and is a well known cause of reactivation of hepatitis B.