Infliximab

Infliximab is used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).

When infliximab is used to treat RA, methotrexate (MTX) is always used in combination. This helps to optimize your therapy with infliximab. Infliximab may be used as monotherapy to treat PsA and AS.

Infliximab is usually delivered by intravenous infusion. A biosimilar version has been approved which is administered by subcutaneous injection and used for maintenance therapy.

The dose of infliximab depends on your body weight. Infliximab is given by infusion initially, then again at week two and week six. Following this, an infusion is given every four to eight weeks depending on the condition you are being treated for and your response to treatment.

A biosimilar version of infliximab given subcutaneously can be used for maintenance after initial induction with infusion administration. The subcutaneous maintenance dose is 120 mg every 2 weeks, which can be started 8 weeks after the last intravenous infusion dose.  

In some people with arthritis, a signalling protein called a tumour necrosis factor (TNF) is present in the blood and joint in excessive amounts where it increases inflammation. Infliximab works by suppressing the body’s immune system, specifically it binds to tumour necrosis factor and prevents it from causing inflammation. By doing this, infliximab can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

As with all of the biologics, you may not feel the effects of the infliximab right away. Some people begin to feel the effects of the medication fairly quickly; however, it may take three to six months to feel its full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for infliximab to take effect, your healthcare provider may recommend taking a steroid, such as prednisone, or a non-steroidal anti-inflammatory drug (NSAID).

Infliximab can make it more difficult for your body to fight infections. Therefore, people with active infections should not take infliximab. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of infliximab with their healthcare provider. 

Also contact your provider if you are having surgery as you may need to stop infliximab until you are healed and there is no sign of infection.

Infliximab has not been studied in pregnant people or lactating parents so its effect(s) on pregnant people or nursing babies are unknown. You should tell your doctor if you are pregnant, or are planning to become pregnant. Because of the potential for adverse reactions in nursing infants, a decision should be made with your healthcare provider on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the lactating parent.

Anyone who has had a previous allergic reaction to infliximab should avoid the medication.
People with a history of cancer or nervous system problems, such as multiple sclerosis, should discuss the use of infliximab with their healthcare provider before starting the medication.

Infliximab may make a condition called congestive heart failure worse. Tell your doctor if you have congestive heart failure.

Before starting this medication, you will likely be tested for inactive (“latent”) tuberculosis (TB) and hepatitis B because infliximab can dampen the immune system and cause these infections to become active. If TB or hepatitis is found, it will need to be treated before you start infliximab.

Ideally, your vaccinations should be up to date prior to starting infliximab. If you have already started therapy with infliximab, your healthcare provider will likely recommend most inactive vaccines (e.g., influenza, pneumococcal). Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking infliximab, you should speak with your healthcare provider.

Like all medications, taking infliximab carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from infliximab. When monitored properly the vast majority of side effects are rare and most improve over time and are reversible.

Infliximab can increase your risk of infections. You should take precautions to minimize your risk of being infected by common contagious infections such as COVID-19, influenzae, pneumonia, and the common cold.

Infliximab can in rare cases cause an allergic reaction during the infusion (flushing, itching, changes in heart rate and blood pressure, etc.). A healthcare professional will monitor for this reaction during the infusion. 
In rare cases, people experience headaches, nausea, abdominal pain and diarrhea with infliximab. If this becomes severe, please consult your healthcare provider.

Some people have developed lupus-like symptoms that disappeared after the medication was stopped. If you have chest pains that do not go away, shortness of breath or a rash on your cheeks or arms that gets worse in the sun, call your doctor right away.

There have been rare cases of disorders that affect the nervous system of people taking infliximab or other TNF-blockers. Signs that you could be experiencing a problem affecting your nervous system include numbness or tingling, problems with your vision, weakness in your legs, and dizziness.

Infliximab very rarely can cause a drop in drop in the number of certain types of blood cells or problems with the liver.

Take infliximab as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

If you experience an infusion reaction while taking infliximab, prior to your next infusion your healthcare provider may recommend a medication pre-treatment to prevent this. Your prescriber may also recommend a longer infusion time.

Keeping yourself well hydrated before getting your infusion and drinking while you get your infusion may also help reduce side effects.

If using the subcutaneous injection therapy, rotate the injection sites and do not inject into damaged skin areas.

Your healthcare provider may order periodic blood tests to check your blood count and liver function and to follow the activity of your arthritis.

Infliximab must be refrigerated at 2 to 8 degrees Celsius and protected from light. Keep the product in the original package and out of the light.  

Infliximab must be kept cool while travelling. Ask your pharmacist for a cool carrier if you are not able to put the drug in your refrigerator right away.  

With the subcutaneous injection pen, it may be transferred to room temperature (up to 25 degrees Celsius) and will be stable for 28 days. It cannot be returned to the fridge for storage and must be disposed of by returning to the pharmacy after this time if not used.  

Each version of infliximab has its own patient support program. These can be found in the list below. 

• Avsola
  PSP: Enliven  (1-877-936-2735) 
• Inflectra
  PSP: Pfizerflex (1-855-935-3539) 
• Ixifi
  PSP: To be announced
• Omvyence
  PSP: To be announced 
• Remicade
  PSP: Bioadvance (1-844-214-4714) 
• Remsima
  PSP: Celltrion CONNECT (1-855-966-1648) 
• Renflexis
  PSP: Harmony (1-866-556-5663)