Infliximab

Infliximab (Remicade)
1. Original prototype drug with release in 1998 for Crohn's Disease, with expanding indications since
Multiple biosimilar agents ( Ixifi, Inflectra, Renflexis) are available
1. Unknown efficacy of switching between agents

See Monoclonal Antibody for preparation for use
Background
1. Unlike other modern TNF agents, Infliximab is by facility infusion (not for home use)
2. Infuse over 2 hours
3. Be prepared for Anaphylaxis during infusion and delayed reaction may occur
4. Consider pretreatment with Antihistamines, Corticosteroids and Acetaminophen to reduce injection reactions
Crohns Disease and Ulcerative Colitis (adults and age >= 6 years)
1. Initial: 5 mg/kg IV at 0 weeks, 2 weeks and 6 weeks
2. Maintenance: 5 mg/kg IV every 8 weeks
3. Consider discontinuation if no response by 14 weeks
4. Consider increasing dose to 10 mg/kg IV if response wanes with continued use
Plaque Psoriasis
1. Initial: 5 mg/kg IV at 0 weeks, 2 weeks and 6 weeks
2. Maintenance: 5 mg/kg IV every 8 weeks
Ankylosing Spondylitis
1. Initial: 5 mg/kg IV at 0 weeks, 2 weeks and 6 weeks
2. Maintenance: 5 mg/kg IV every 6 weeks
Rheumatoid Arthritis or Juvenile Idiopathic Arthritis (off-label use for age >= 4 years)
1. Initial: 3 mg/kg IV at 0 weeks, 2 weeks and 6 weeks
2. Maintenance: 3 mg/kg IV every 8 weeks (6x/year)
3. Dosing range is 3-10 mg/kg (typically higher doses than 3 mg are needed with longterm use)

See TNF Inhibitor
TNF Inhibitors predispose to serious infections and malignancy
Prepare for TNF Inhibitor use with infection screening (e.g. Tuberculosis) and Immunizations
1. See Monoclonal Antibody

Among the most potent of TNF Inhibitors (consider in severe, fulminant disease)
Crohns Disease
1. Significant response to remission even with fistulas
2. Relapse may occur after 3 months

Considered safe in Lactation
Pregnancy
1. May use in pregnancy (any trimester) if indicated and benefit outweighs risk
2. Exposure risk increases after 20 weeks (monitored by registry)