Infliximab

• You must see your rheumatologist regularly to make sure the treatment is working and check for possible side effects.
• You should have regular blood tests as suggested by your rheumatologist.
• It is important to tell your rheumatologist if you have a new serious illness such as a serious infection, cancer or heart failure.
• If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
• If you stop infliximab for any reason, you must contact your rheumatologist. Failure to do so may mean that your treatment may no longer be subsidised.
• If you plan to become pregnant, you must discuss the timing with your rheumatologist

• You may notice lessening of joint swelling, pain and stiffness, often within the first 8 weeks of starting.

• If you stop or delay your infliximab treatment, you may worsen again. Keep taking infliximab, unless told by your rheumatologist to stop or unless serious side effects occur (see Side effects).
• If you stop infliximab for any reason, you must contact your rheumatologist. Failure to do so may mean that your treatment may no longer be subsidised.

There are also biosimilar infliximab medications. A biosimilar is a version of infliximab that has been shown to have similar benefits and safety as the original brand. You should not switch between different brands of infliximab unless told to do so by your rheumatologist. Make sure you are given  the same brand each time. If you need to change brands, your rheumatologist will advise you and will check for side effects.

• Medications like infliximab are very expensive and highly subsidised by Medicare. Certain conditions must be met to receive it.
• Infliximab will only be given if your disease is active and if standard treatments have not worked.
• It will only be continued if it helps your condition. This must be checked between 12 and 16 weeks after the start of treatment.
• Blood tests are needed during your treatment to watch for side effects and decide if the treatment is working.
• How often you have blood tests will depend on what other medications you are taking and what other illnesses you might have. Your rheumatologist will advise on this.

• Infliximab is given either as a drip (infusion) into the vein or by an injection under the skin (subcutaneous injection). Treatment can begin as either: 
  • two infusions spaced two weeks apart, followed by either by infusion or subcutaneous injection 4 weeks later or
  • as weekly subcutaneous injections, followed by fortnightly injections thereafter.

The timing of remaining doses depends on your condition and the chosen method of administration. Your rheumatologist will work with you to decide what is best for you. 

Infusion: The infusion normally takes 1 to 4 hours. You will need to stay for at least an hour after the infusion to make sure you do not have any immediate side effects.

Subcutaneous injection: Infliximab (Remsima only) may be injected subcutaneously by your doctor, nurse or carer or by you. If you inject yourself, be sure to follow the detailed instructions carefully to ensure the best response. It is important to change the injection site each time.

• Infliximab is often given in combination with the DMARD methotrexate.
• Sometimes a cortisone medicine may be used to lessen side effects (see Are there any side effects).

• The dosage is based on body weight so each person’s dose will vary.

Infliximab may be safely used with other arthritis medicines including:

• other DMARDs such as methotrexate
• steroid medicines such as prednisolone or cortisone injections into the joint
• anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen, Nurofen)
• simple pain medicines such as paracetamol.

Infliximab cannot be used with other bDMARDs.
 
There are separate information sheets on the ARA website for the medicines mentioned above.

You might experience side effects with your treatment. Contact your rheumatologist if you have any concerns about possible side effects. Many side effects go away when infliximab is stopped.

Most common possible side effects

• Side effects can occur during the infusion. These may include fever or chills, itch, chest pain, shortness of breath or changes in blood pressure. These effects are more likely to occur during the first or second infusion and can often be lessened by giving steroids, anti- histamines and paracetamol before the treatment.
• Headaches, cough, stomach and bowel discomfort may also occur.
• As infliximab affects the immune system, mild infections, mainly the upper respiratory tract (e.g. colds, sinusitis) may occur more often. Treatment with infliximab may need to be briefly stopped for a serious infection so contact your rheumatologist for advice.

Less common or rare possible side effects

• Serious infections such as tuberculosis (TB) are seen rarely, and screening for TB is needed before treatment begins.
• Rarely, infliximab may cause an allergic reaction with itchy, red skin or a rash or a feeling of tightness in the chest and trouble breathing.
• Side effects involving the nerves, such as inflammation of the nerve to the eye, may also occur rarely, causing changes in vision or sensation.
• Very rarely ‘drug-induced lupus’ has occurred with symptoms of rash, fever and increased joint pain.
• Annual skin checks are suggested with any medications that can suppress the immune system as there is a slight increase in risk in skin cancers. To date research and use over 20 years, have not shown an increase in risk of other cancers.

Infections

• If you have a current infection of any kind treatment with infliximab should not be given until the infection is treated.
• You will need some blood tests and a chest X-Ray to exclude some chronic infections before your first bDMARD.

Use with other diseases
Worsening may occur of the following conditions:

• multiple sclerosis.
• moderate to severe heart failure.
• systemic lupus erythematosus (lupus/SLE) People with SLE are not often given infliximab but each case will be assessed whether safe by your rheumatologist.

Use with other medicines

• Infliximab can interact with other medicines. You should tell all your doctors about all medicines you are taking or plan to take. This includes over the counter or herbal/naturopathic medicines.

Vaccines
If you are taking infliximab you should not be immunised with ‘live’ vaccines such as

• MMR (measles, mumps and rubella), Varicella vaccine (Chicken pox), OPV (oral polio virus), BCG (Bacillus Calmette Guerin), Japanese Encephalitis or Yellow Fever. Talk with your rheumatologist before receiving any vaccines.
• Pneumococcal vaccines, the yearly seasonal flu and COVID-19 vaccinations are safe and encouraged.

More information is available on Vaccinations in Rhematology and COVID-19 vaccination.

Surgery

• If you need surgery for any reason, infliximab should be stopped before surgery. It can start again after the operation at a time decided by your surgeon and rheumatologist, (often once the wound has healed as long as there is no infection).

Use with alcohol

• You may drink alcohol while taking infliximab. If you are also taking methotrexate you should be cautious about how much alcohol you drink.

Use in pregnancy and when breastfeeding

• It is important to discuss with you doctor if you are planning a pregnancy while on infliximab.
• It may be used in pregnancy and in men trying to father a child.
• If infliximab is kept going beyond 4 months of pregnancy it may increase the risk of infection in the newborn when live vaccines may be due. 
• The rotavirus vaccine should be given within the  first 6 months of life. MMR may be given at 6 months. 
• There is only limited information regarding infliximab in breast milk and while small amounts may occur, it does not seem to be harmful.

• Store infliximab in the refrigerator, between 2-8oC. Do not freeze. Keep the syringes or pens in the original carton to protect them from light until the time of use. Do not shake the vials.
• Keep all medicines out of reach of children.

• After injecting infliximab, the used syringes/pens should be placed in a sharps container. Dispose of your sharps container according to your state or local regulations. If unsure how to dispose of your sharps container, ask your pharmacist.
• If your doctor tells you to stop using infliximab, or the expiry date has passed, ask your pharmacist what to do with the leftover medicine.