Infliximab (infusion), sold under the brand name Remicade, comes in the form of a liquid solution. It is typically used to treat and prevent the progression of certain types of arthritis, skin diseases, and bowel diseases. As a second-line treatment, Infliximab is usually prescribed only after other treatments have proven unsuccessful. In this article, we’ll answer some of the most common questions about Infliximab, including its uses, side effects, and interactions.

What is Infliximab?

Infliximab is a TNF-blocker drug that belongs to a group of medicines called biological disease-modifying anti-rheumatic drugs (DMARDs). It is typically used to prevent the progression of certain types of moderate-to-severely active arthritis (rheumatoid arthritis, psoriatic arthritis), skin diseases (plaque psoriasis), and bowel diseases (Crohn’s disease and ulcerative colitis).

Infliximab usually acts as a second-line treatment, which means it is only prescribed after other first-line treatments, for example, the DMARD Hydroxychloroquine (Plaquenil), have proven unsuccessful or have caused adverse side effects. It is also possible to receive Infliximab in tandem with other drugs, such as Methotrexate (Trexall).

Furthermore, Infliximab comes in liquid form. It needs to be given directly into the bloodstream via infusion method because our digestive system will destroy it if it is given orally.

If you have rheumatoid arthritis and are considering infusion therapy, check out our blog Rheumatoid Arthritis: Infusion Therapy Explained. In this article, we’ve covered some of the most frequent questions about infusion therapy, including the key advantage of infusion therapy, which infusion medication will you receive, and its cost.

How does Infliximab work?

Infliximab works by targeting a protein in the body called TNF-alpha which is produced naturally by our immune system as a part of the immune response. This TNF-alpha attacks the affected areas (as the fighting mechanism against infections) and causes inflammation. Infliximab blocks this action, and ultimately helps decrease the inflammation (swelling) as well as slows down the damage it causes.

How do I take Infliximab and how long does the process take?

Infliximab is given as an infusion into a vein in your arm or hand. You can receive the infusion in an infusion center or a hospital. The infusions rooms are designed to make patients feel relaxed and usually equipped with recliners, pillows, and blankets. During the infusion, you may find it helpful to do something relaxing, such as reading or playing a video game on your phone. Some hospitals also provide a home care service that allows you to have your infusions at home.

The Infliximab infusion usually takes about two hours and you may need to stay for another couple of hours after the infusion has finished before you’re discharged. The extra two hours are designated to make sure that you don’t develop any side effects (such as allergic reaction). That being said, most treatment sessions take 4-6 hours in total. However, different hospitals may have a different approach and may allow patients to go home right after the infusion has finished.

How often do I have to take Infliximab?

After the first infusion, you’ll receive the second treatment in the next 2 to 6 weeks. If you are responding properly to the treatment, you’ll be on a maintenance schedule and receive infusion every 8 weeks.

What is the normal dosage of Infliximab?

The recommended dose is 5 mg of Infliximab for every kilogram you weigh. The medical personnel will ensure you receive the right dose, so you don’t need to do anything.

How long will Infliximab take to work?

The response to the treatment varies from patient to patient. Some people may feel better within a few days after the first treatment, whereas in most cases, Infliximab may take 2-6 weeks to work.

How long will I be on Infliximab?

The treatment with Infliximab can continue long-term. Usually, you’ll be reassessed by your doctor at least annually to determine whether the treatment is right for you. In some cases, Infliximab can lose its effectiveness over time which means the dose has to be increased or given more often to get the same effect as before. If Infliximab has become less responsive in slowing down the ongoing inflammation, you may be suggested other biological drugs, such as Adalimumab, Golimumab, or Vedolizumab.

Will I be prescribed another drug alongside Infliximab?

Your doctor may give you other immunosuppressant drugs, such as Azathioprine or Methotrexate, along with Infliximab. There is some evidence that a drug combination could be beneficial, especially those who have Crohn’s disease or Ulcerative Colitis. Immunosuppressant drugs can prevent your immune system from reacting against Infliximab.

However, some studies claim that the combination of Infliximab with immunosuppressant drugs doesn’t show significant improvements in some patients; others suggest the combination may increase the risk of side effects, such as infections.

What are the side effects of Infliximab?

Like all drugs, Infliximab could cause side effects, although they are uncommon. Some patients may show immediate side effects (in direct response to the infusion), while for others, the side effects may not appear for several days, weeks, or even months. Remember that each patient can react differently to Infliximab. You should have a discussion with your doctor about the risks and benefits of taking Infliximab before starting the treatment so that you can agree what is the best treatment option in your circumstances.

Infusion site reaction (redness, itching, pain, or swelling) is one of the common side effects of taking infusion medication. Some other possible side effects of Infliximab are listed in the following list. If you are experiencing any of these symptoms, seek emergency medical attention.

• Allergic reaction – allergic reaction can occur during the infusion, soon after the treatment, or up to 12 days after you receive the medication. The symptoms include swollen face and lips, difficulty in swallowing or breathing, pains in the chest or joints, fever or chills, headaches, and sore throat.
• Skin reaction – such as skin rashes (red, raise, itchy patches of skin), ulcers and hives, and psoriasis (rarely occurs).
• Infection reaction – since Infliximab suppresses the immune system, you might develop some signs of infection. It can range from something mild (common cold) to more serious infections (pneumonia and septicemia/blood infection).
• Heart problems – such as shortness of breath, sudden weight gain, and swelling of the ankles.

The above list isn’t a complete list of all possible side effects of Infliximab. Tell your doctor or the hospital team monitoring your treatment about any new symptoms that you notice, including if it isn’t mentioned above.

Once your treatment has started, you will need to check your condition regularly. You may also need to take additional blood tests to make sure that any complications are prevented or caught at an early stage.

What should I tell my doctor before starting Infliximab?

Some people may not be suitable for using Infliximab. To make sure this medicine is safe for you, tell your doctor about your past and current health conditions, including if you:

• Have or have had cancer
• Have or had heart problems
• Have diabetes
• Have or have had hepatitis B
• Have an infection, are being treated for infection, or have symptoms of an infection
• Have tuberculosis (TB) or have been in close contact with someone with TB, or travelled where there is more risk for getting TB
• Have numbness or tingling or a nervous system disease such as multiple sclerosis
• Have recently received or are scheduled to receive a vaccine
• Have been in contact with people who have chickenpox, shingles, measles, or pneumococcal disease
• Are scheduled for major surgery or dental treatments
• Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed

This isn’t a complete list of all the conditions that may interact with Infliximab. To avoid any unwanted effects, talk with your doctor.

Will I need to take any special precautions while being treated with Infliximab?

Here are some things that you should take special care of while receiving Infliximab:

• You may feel drowsy and tired after you receive the infusion, especially if you were given medication to reduce side effects. It could be a good idea if you arrange a taxi or ask someone to drive you home.
• You may be more prone to infections since Infliximab affects your immune system. Avoid contact with people who have infections that may spread (such as chickenpox, measles, and flu).
• Wash your hands well and keep your house clean and hygienic to minimize the chance of getting infected.
• Be mindful of what you eat. Avoid eating raw eggs, undercooked meat and poultry, unpasteurized daily products, and soft or blue cheeses.
• Discuss with your doctor before getting vaccinated and avoid contact with people who have recently received live vaccines, such as FluMist (nasal flu vaccine), mumps, and rubella.

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