Infliximab is an anti TNF approved by NICE for use in AS.
Although infliximab has been available for some time, it was not initially approved by NICE on the grounds of cost efficacy. However, in 2015, NICE re-assessed the evidence and have allowed rheumatologists to prescribe infliximab. The guidance states that rheumatologists must choose the cheapest available option.
The three brands of infliximab available in the UK at the moment are Remicade, Remsima and Inflectra. Remicade is the original product and Remsima and Inflectra are what are known as biosimilars.
How it is taken
Infliximab is only available on prescription from a consultant rheumatologist.
It is given by intravenous drip into your arm. It's usually done in a hospital out patient clinic. The infusion is given over two hours (this may change to one hour later on in treatment) and you'll have to wait for another 1-2 hours afterwards before you can go home in case you develop any side effects such as an allergic reaction.
After the first infusion you may well have another two weeks later and then again four weeks after that. Once your treatment is established you usually have an infusion every eight weeks.
Time infliximab takes to work
If you respond to infliximab your symptoms will start to improve in 2-12 weeks.
Possible side effects
The most common side effects of infliximab are:
- blocked or runny nose
- stomach pain or indigestion
Taking infliximab can sometimes affect the blood count (the number of blood cells present in your blood) and can make you more likely to develop infections. Avoid close contact with people with infections and be extra careful with food safety.
You should tell your doctor or rheumatology nurse straight away if you develop any of the following:
- sore throat
- any other symptoms of infection such as coughing up green phlegm or diarrhoea
- 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. You may need antiviral treatment, which your doctor will be able to prescribe.
Potential risks associated with infliximab
There may be a slightly increased risk of some cancers with infliximab as it interferes with the immune system. This is theoretically possible because the immune system is involved in recognising and killing cancerous cells. It's important to bear in mind that this link hasn't been proven and is still being extensively researched. A a review in 2012 of studies involving over 25,000 patients found no increase in the risk of cancer.
Very rarely, people taking infliximab may develop a condition called drug induced lupus. This is usually mild and can be diagnosed by a blood test. Symptoms include a rash, fever and increased joint pain. If you develop drug-induced lupus, the infliximab will be stopped and the condition then usually disappears.
If you're taking infliximab it's recommended that you avoid live vaccines such as yellow fever. If you do need a live vaccine do discuss all the possible risks and benefits of the vaccination with your doctor.
If you're in your 70s your doctor may advise you to have the shingles vaccination (Zostavax) before starting infliximab. This vaccination is not recommended for people who are already on infliximab.
Pneumovax (pneumonia) and yearly flu vaccines are recommended for everyone on infliximab.
Infliximab may be prescribed along with other medicines. Do discuss any new medications with your doctor before starting them, and always tell any 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.
There is no known interaction between infliximab and alcohol.
Infliximab and surgery
If you are going to have an operation please inform your doctor, as you are likely to be advised to stop infliximab temporarily before and after surgery.
Infliximab and fertility or pregnancy
The British Society for Rheumatology produced new guidelines on the use of anti TNF therapy such as infliximab during pregnancy.
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