Infliximab

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A chimeric monoclonal IgG1 antibody directed against tumour necrosis factor alpha (TNF-α). Inflixmab is used to treat diseases in which TNF-α is thought to be a significant cytokine mediator of inflammation. By neutralising the biological effect of TNF-α, infliximab is thought to attenuate the imbalance of inflammation. It has been used in conditions that include:

As it is a mouse/human chimera, infliximab is immunogenic and can induce antibodies to itself. This can adversely affect its subsequent administration and efficacy. An human recombinant alternative called Adalimumab is thought to avoid these problems.

Issues

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Brand name prescribing is now vital as 3 similar products are on the market but have different properties[5]

Anti-TNF antibody Side-effects

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  • Latent tuberculosis should be excluded[6]
  • Withdrawal of the anti-TNF therapy in a secondary lung malignancy that expressed TNF receptors lead to tumour regression[7]
  • Infections, including severe sepsis (odds ratio for serious infection 2.0 (95% CI, 1.3-3.1), number needed to harm 59 (95% CI, 39-125) within a treatment period of 3 to 12 months).
  • Malignancy (odds ratio for malignancy 3.3 (95% CI, 1.2-9.1) number needed to harm 154 (95% CI, 91-500) for 1 additional malignancy within period of 6 to 12 months), including an association with hepatosplenic T-cell lymphoma in patients also on mercaptopurines.

References to side-effects[8] [9]

References

  1. Belluzzi. Review: infliximab increases response and remission rates in fistulising or treatment-resistant Crohn's disease. Evid Based Med. 2002;7:186
  2. Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, et al. Infliximab maintenance therapy for fistulizing Crohn's disease. The New England journal of medicine 2004;350(9):876-85. (Direct link – subscription may be required.)
  3. Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. The New England journal of medicine 2005;353(23):2462-76. (Direct link – subscription may be required.)
  4. UKMI Infliximab in psoriasis
  5. UKMI IN-USE PRODUCT SAFETY ASSESSMENT REPORT REMSIMA® AND INFLECTRA® (INFLIXIMAB BIOSIMILARS) accessed 28.02.2015
  6. Theis VS, Rhodes JM. Review article: minimizing tuberculosis during anti-tumour necrosis factor-alpha treatment of inflammatory bowel disease. Alimentary pharmacology & therapeutics. 2008 Jan 1; 27(1):19-30.(Link to article – subscription may be required.)
  7. Lees CW, Wallace WAH, Satsangi J. Resolution of Non-small-Cell Lung Cancer after Withdrawal of Anti-TNF Therapy. NEJM 2008;359:320-1
  8. Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA : the journal of the American Medical Association 2006;295(19):2275-85. (Direct link – subscription may be required.)
  9. Rosh JR, Gross T, Mamula P, Griffiths A, Hyams J. Hepatosplenic T-cell lymphoma in adolescents and young adults with Crohn's disease: A cautionary tale? Inflamm Bowel Dis 2007. (Direct link – subscription may be required.)
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