Infliximab contraindications

If there are no contraindications, infliximab 5 mg/kg followed by 5 mg/kg at weeks 2 and 6 may be used for severe active CD. There is no evidence that infliximab is either safe or effective for fulminant disease. 

Infliximab should not be given to individuals with known hypersensitivity to murine proteins. As with etanercept, precautions for the prevention of serious infections must be taken, and live virus vaccines are contraindicated. 

Infliximab therapy is associated with increased incidence of respiratory infections of particular concern is potential reactivation of tuberculosis or other granulomatous infections with subsequent dissemination. The FDA recommends that candidates for infliximab therapy should be tested for latent tuberculosis with purified protein derivative, and patients who test positive should be treated prophylactically with isoniazid. However, anergy with a false-negative skin test has been noted in some patients with Crohn s disease, and some experts routinely perform chest radiographs to look for active or latent pulmonary disease. Infliximab also is contraindicated in patients with severe congestive heart failure. The significant cost of infliximab is an important consideration in some patients. 

TNF-a antagonists are contraindicated in patients with advanced left ventricular disease. Both etanercept and infliximab were associated with increased mortality in patients with severe congestive heart failure (291,292). 

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