Infliximab

Infliximab (brand name Remicade) is a type of drug known as anti-TNF (anti-tumour necrosis factor). In people with rheumatoid arthritis and some other inflammatory diseases a protein called TNF is overproduced in the body, causing inflammation and damage to bones, cartilage and tissue. Anti-TNF drugs block the action of TNF and so can reduce this inflammation.

Why is infliximab prescribed?

Infliximab is available for people with rheumatoid arthritis and psoriatic arthritis. Occasionally it is used in 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 gold injections, or cannot use these. Slightly different conditions may apply in the case of the other diseases.

Infliximab will not be prescribed if:

your rheumatoid arthritis is not active
you have not tried standard treatments first
you are pregnant or breastfeeding
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 or have had multiple sclerosis (MS)
you have had cancer
you have or have had a serious heart condition
you have lung fibrosis.

When and how do I take infliximab?

Infliximab is only available on prescription from a consultant rheumatologist. Infliximab is given by intravenous infusion (through a drip into a vein). You will need to go to the hospital each time you have an infusion. The infusion is given over 2 hours (later on in treatment, infusions may sometimes be given over 1 hour) and you will have to wait for another 1–2 hours afterwards before you can go home in case you develop any unwanted side-effects of the treatment.

After the first infusion of infliximab you will have another one 2 weeks later and then one 4 weeks after that. After the third infusion, you will continue to have infusions every 8 weeks.

If you are being prescribed infliximab it is recommended that you carry a biological therapy alert card, which you can obtain from your doctor or rheumatology nurse specialist. 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.

How long does infliximab take to work?

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

What are the possible risks or side-effects?

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

In some people taking infliximab, the 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
unexplained bruising, bleeding or paleness
any other new symptoms or anything else that concerns you.

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 in people who are on treatments such as infliximab which affect the immune system (the body's own defence system). Therefore you may need antiviral treatment, which your doctor will be able to prescribe.

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. If this happens, urgent medical attention is required. If the reaction is severe, then treatment cannot be continued.

Also very rarely, people taking infliximab may develop a condition called ‘drug-induced lupus’, which is usually mild. The symptoms are a rash, fever and increased joint pain. Your doctor will check for this with a blood test. If you develop drug-induced lupus, the infliximab will be stopped and the condition usually then disappears.

It is possible that there may be a slightly increased risk of certain types of cancer in patients using anti-TNF drugs. Such a link has not been proven but is the subject of current research. Please discuss this with your doctor if you are concerned. Anti-TNF drugs have been associated with certain types of skin cancer – these can be readily treated when diagnosed early.

As yet, the long-term side-effects of infliximab are not fully understood because it is a relatively new drug.

How can I reduce the risk of infection?

Because of its effects on the immune system, infliximab may make you more susceptible to food-borne infections such as salmonella and listeria, which can result in food poisoning and other serious illnesses. You can minimise this risk by avoiding foods such as:

raw eggs or products made from raw eggs (such as mayonnaise, although many commercially available products are safe)
unpasteurised milk
mould-ripened soft cheeses (e.g. Brie and Camembert) and blue cheeses (whether pasteurised or unpasteurised), feta and goat's cheese
undercooked meat and poultry
all types of pâté.

You should also wash all raw fruit and vegetables and ensure that chilled ready meals are thoroughly cooked before eating. For further advice see the Food Standards Agency website: www.eatwell.gov.uk/keepingfoodsafe.

What other treatments could be used instead of infliximab?

A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions. Your doctor 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 before starting treatment. You may also have further blood tests while you are on infliximab to monitor its effects.

Can I take other medicines along with 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.

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.

Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.

What about immunisations?

If you are on infliximab it is recommended that you should not be immunised with 'live' vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the immunisation with you.

Pneumovax (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines are safe and recommended.

Can I drink alcohol while on infliximab?

You can drink alcohol while on infliximab, but, because you are likely to be taking methotrexate as well, you should only drink it in small amounts. This is because methotrexate and alcohol can interact and damage your liver.

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

If you are going to have an operation please inform your doctor, as you may be advised to stop the infliximab temporarily before and after surgery.

Does infliximab affect fertility or pregnancy?

No-one knows the risk of infliximab to an unborn baby. Women of childbearing age therefore must use contraception while on infliximab. You should not have infliximab if you are thinking of becoming pregnant in the near future or if you are not using contraception.

It is recommended that women do not become pregnant for at least 6 months after the last dose of infliximab.

What about breastfeeding?

You should not breastfeed if you are on infliximab. The drug may pass into the breast milk and could be harmful to your baby.

Where can I obtain further information?

If you would like any further information about infliximab, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.

Remember to keep all medicines out of reach of children.

PLEASE NOTE: We have made every effort to ensure that this content is correct at time of publication, but remember that information about drugs may change. This page is for general education only and does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet that comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects that may be relevant in your particular case.

Our drug information is revised annually and published at the start of the year.