Side effects and management

Infliximab: An overview
Th 17 cells produce cytokines such as TNF
TNF is involved in the inflammatory response
Infliximab is given via an IV infusion
 Infliximab: Common side-effects
Hypersensitivity reactions – 1-2hrs after infusion
 Fever
 Puritus

 Rash
 Infliximab: Less common Side-effects
Constipation
Palpitations
Arrhythmias
Epistaxis
Myalgia
Ecchymosis
Infliximab: Rare Side-effects
Hepatitis
Intestinal stenosis
Intestinal perforation
Side effects: management
Observe patient closely during infusion & 1-2 hrs. post
infusion
Resuscitation trolley nearby
Role of prophylaxis meds eg.
 Anti pyretics
 Anti-histamines
 Hydrocortisone
 Anti-emetics
• Take home meds
• During a hypersensitivity attack → Chlopheniramine &
hydrocortisone IV/IM
 Major cautions when using Infliximab
Predisposition to infections
 Fungal infections
 ↑ risk of Non-Hodgkins lymphoma
 Tuberculosis → Need to assess for TB pre & post
treatment

Hepatitis B → monitor for reactivation

Heart failure can worsen
 Risk of sepsis with Infliximab
REFERENCE STUDY DESIGN NO. OF NO. OF
PATIENTS DEATHS FROM
SEPSIS

LJ Ung et al.GUT Population based 191 1

2004;53:849-853 cohort
Seiderer et al.Digestion Single centre 92 0
2004;70:3-9 cohort
Colombel et al.Gastro Single centre 500 5
2004;126:19-31 cohort
Sands et al.NEJM RCT 282 2
2004;350:876-885
Hanauer et al.Lancet RCT 573 1
2002; 359:1541-1549
Rutgeerts et al.Gastro RCT 73 0
1999; 117: 761-769
 Antibodies (ATI) to Infliximab
ATI develop in patients receiving infusions

ATI tends to ↑ risk of infusion rxns

ATI ↓ remission time

 Episodic vs. Maintainance dosing
Rutgeerts et al. Gastro 2004
Episodic Rx had 28.1% risk of developing ATI

Maintenance dosing of 5mg/kg q 8 wks had a 9.1%

risk of developing ATI

Maintenance dosing of 10mg/kg q 8 wks had a 6.3%

risk of developing ATI
 Immunomodulators with episodic
Infliximab
Baert et al. NEJM 2003; 348
 Patients on episodic R x + Immunomodulators →
43% develop ATI

 Patients NOT on immunomodulators → 75% dev.

ATI
 Protection against ATIs
Study by Farrell et al. Gastro 2003; 124:91
• Protective factors against ATI such as
 Combination Rx with immunomodulators
(Azothioprine, 6-MP or MTX)
 2nd infusion within 8 wks
 Concurrent prednisolone > 20mg/day