Infliximab - Royal Berkshire Hospital

Drug information sheet
Infliximab
What is infliximab?
Infliximab (brand name Remicade) is a biologic drug which blocks an important component
of inflammation called Tumour Necrosis Factor alpha (TNF). It is used to treat
inflammatory diseases such as Crohn’s disease and rheumatoid arthritis. In people with
these diseases a protein called TNF is present in the blood and joints in excessive
amounts, causing increased 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,
psoriatis arthritis, ankylosing spondylitis and Crohn’s disease.
Why am I being prescribed infliximab?
Infliximab is available for people with rheumatoid arthritis, psoriatic arthritis, ankylosing
spondylitis and Crohn’s disease. It will only be prescribed if you have already tried and not
responded to standard treatments and if surgery is considered inappropriate. It may also
be prescribed if you cannot tolerate other treatments.
Infliximab is available only on prescription from a consultant rheumatologist.
Infliximab will not be prescribed if:
 Your rheumatoid arthritis or Crohn’s disease 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 a fistula that is leaking pus.
 You have or have had multiple sclerosis (MS).
 You have ever had hepatitis B or have been in close contact with someone who has
hepatitis B.
 You have had cancer.
 You have or have had a serious heart condition.
 You have had or have ever lived in a region where histoplasmosis or coccidioidomycosis
(fungal diseases) are common (e.g. parts of the USA, South America and Africa).
Infliximab, Reviewed by Consultant Rheumatologist Dr Jeremy McNally FRCP October 2014. Review due: October
2016
Drug information sheet – Infliximab
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.
Advice following treatment with infliximab
 You should be able to continue with your normal activities after treatment, although you
may feel tired. If you feel unwell or tired, do not drive or operate machinery.
 Avoid contact with people who have infections such as colds, ‘flu, fever and fungal infections.
 Do not have any live vaccines such as polio, yellow fever, rubella (German measles),
MMR (measles, mumps and rubella) and BCG (TB) whilst you are being treated with
infliximab. 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.
 Avoid pregnancy for at least 6 months after stopping treatment if either you or your
partner are being treated with infliximab.
 Avoid breastfeeding for at least 6 months after stopping treatment.
 Avoid excessive alcohol consumption, particularly if you are also taking methotrexate.
 Check first with your doctor or nurse before taking any other medicines, including herbal
remedies and ‘over the counter’ medicines.
 If you see another doctor, nurse or dentist, tell them you are taking infliximab.
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
Infliximab, Reviewed by Consultant Rheumatologist Dr Jeremy McNally FRCP October 2014. Review due: October
2016
2
Drug information sheet – Infliximab
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 Crohn’s disease, rheumatoid arthritis
and related conditions. 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. 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.
Infliximab, Reviewed by Consultant Rheumatologist Dr Jeremy McNally FRCP October 2014. Review due: October
2016
3
Drug information sheet – Infliximab
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.
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.
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.
Useful contacts
 National Association for Colitis and Crohn’s Disease (NACC)
0845 130 2233
www.nacc.org.uk
 CORE
www.corecharity.org.uk
 Arthritis Care
www.arthritiscare.org.uk
 National Rheumatoid Arthritis Society
www.rheumatoid.org.uk/
For further information about the Trust, visit our website www.royalberkshire.nhs.uk
RHEU_1395
West Berkshire Rheumatology Unit
Reviewed: October 2014
Review due: October 2016
Infliximab, Reviewed by Consultant Rheumatologist Dr Jeremy McNally FRCP October 2014. Review due: October
2016
4