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ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS › IMMUNOSUPPRESSANTS › IMMUNOSUPPRESSANTS › Tumor necrosis factor alpha (TNF-alpha) inhibitors
infliximab
L04AB02
Forms & Strengths
- Lyophilized powder for injection: 100 mg per single-dose vial
Adult Dosing
- Crohn's disease: 5 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks
- Ulcerative colitis: 5 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks
- Rheumatoid arthritis: 3 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks (in combination with methotrexate)
- Ankylosing spondylitis: 5 mg/kg IV at 0, 2, and 6 weeks, then every 6 weeks
- Psoriatic arthritis: 5 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks
- Plaque psoriasis: 5 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks
Pediatric Dosing
- Pediatric Crohn's disease (>= 6 years): 5 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks
- Pediatric ulcerative colitis (>= 6 years): 5 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks
Indications
- Moderately to severely active Crohn's disease
- Moderately to severely active ulcerative colitis
- Moderately to severely active rheumatoid arthritis (with methotrexate)
- Active ankylosing spondylitis
- Active psoriatic arthritis
- Chronic severe plaque psoriasis
Mechanism of Action
- Chimeric monoclonal IgG1 kappa antibody that neutralizes the biological activity of tumor necrosis factor alpha (TNF-alpha)
- Binds to soluble and transmembrane forms of TNF-alpha
- Inhibits functional activity of TNF-alpha and induces lysis of TNF-expressing cells
Contraindications
- History of hypersensitivity to infliximab, murine proteins, or excipients
- Heart failure NYHA class III/IV at doses > 5 mg/kg
- Severe active infections such as sepsis, abscesses, and active tuberculosis
Adverse Reactions
- Infusion reactions (fever, chills, pruritus, urticaria, hypotension, dyspnea)
- Infections (upper respiratory tract, sinusitis, serious infections, tuberculosis)
- Autoimmune phenomena (drug-induced lupus, autoantibody development)
- Hepatotoxicity (elevated transaminases, severe hepatic injury)
- Malignancies (lymphoma, hepatosplenic T-cell lymphoma in young patients)
- Cardiovascular (worsening or new-onset heart failure)
Drug Interactions
- Live vaccines: risk of disseminated infection; avoid concomitant use
- Anakinra: increased risk of serious infections and neutropenia; avoid co-administration
- Abatacept: increased risk of serious infections without enhanced clinical benefit; avoid
- CYP450 substrates: resolution of chronic inflammation can normalize CYP enzyme activity, potentially altering metabolism of narrow therapeutic index drugs (e.g., warfarin)
Curated Content: Needs Vetting Before Put to Clinical Use