Infliximab
A DRUG Information Sheet
What is infliximab?
Infliximab (brand name Remicade) is a type of drug known as anti-TNF. In people with rheumatoid arthritis and some other inflammatory diseases a protein called TNF is present in the blood and joints in excessive amounts, where it increases inflammation. Anti-TNF drugs block the action of TNF and so can reduce inflammation. In this way they can help people with active rheumatoid arthritis and other types of arthritis.
Why am I being prescribed infliximab?
Infliximab is available for people with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. It will only be prescribed if your rheumatoid arthritis is active and if you have already tried methotrexate and another standard 'second-line' treatment (e.g. sulfasalazine, gold injections). It may also be prescribed if you cannot tolerate other treatments. Slightly different conditions may apply in the case of psoriatic arthritis and ankylosing spondylitis. Infliximab is available only on prescription from a consultant rheumatologist.
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.
When and how do I take infliximab?
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.
After the first infusion of infliximab you will have another 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.
How long will 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, abdominal 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. If you develop a fever, sore throat or other infection, or if you suddenly bruise or bleed very easily or look very pale, you should see your doctor or rheumatology nurse immediately.
If you have not had chickenpox but come into contact with someone who has chickenpox or shingles, or if you develop chickenpox or shingles, you should see your doctor immediately as you may need special treatment. This is because chickenpox and shingles can be severe in people on treatment such as infliximab which has effects on the immune system (the body's own defence system). Therefore you may require antiviral treatment.
Rarely, people may be allergic to infliximab. If this is the case with you, the drug will have to be stopped.
Very rarely, people taking infliximab develop a condition called 'drug-induced lupus', which is usually mild. The symptoms are a rash, fever and increased joint pain. Your rheumatologist will check for this with a blood test. If you develop drug-induced lupus, infliximab will be stopped and the condition usually then disappears.
As yet, the long-term side-effects of infliximab are not known because it is a relatively new drug.
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 (see arc leaflet 'Drugs and Arthritis'). Your rheumatologist will discuss these other options with you.
How can I reduce the risk of infection?
As a result of its action on the immune system, infliximab may make you more susceptible to food-borne infections such as salmonella and listeria, which may 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.
Do 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.
May I take other medicines along with infliximab?
Most people who are on infliximab will also be prescribed methotrexate (see separate arc leaflet 'Methotrexate'). If you are on methotrexate, special care is needed with non-steroidal anti-inflammatory drugs (NSAIDs). You may only take anti-inflammatory drugs if they are prescribed to you by your doctor.
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 taking infliximab.
Infliximab is not a painkiller. So if you are on painkillers you may continue to take these as well as infliximab, unless your doctor advises otherwise.
Do not take over-the-counter preparations without discussing this first with your doctor, rheumatology nurse or pharmacist.
Can I have immunisations while 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 and yearly flu vaccines are safe and recommended.
May I drink alcohol while taking infliximab?
You may drink alcohol while taking 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.
May I continue with infliximab if I am to have an operation?
If you are to undergo surgery, please inform your doctor, as you may be advised to stop the infliximab temporarily before and after surgery.
Does infliximab affect pregnancy?
No-one knows the risk of infliximab to an unborn baby. Women of child-bearing age must use contraception while on infliximab. Do not take 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 and men do not try for a baby with their partner for at least 6 months after the last dose of infliximab.
What about breastfeeding?
Do not breastfeed while on infliximab. The drug could pass into the breast milk and the risk to the baby is unknown.
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 the content of this information sheet is correct at time of going to press, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.
