Infliximab Infusion rate

The most common side effects, which are related to the intravenous infusion itself, include rash, low blood pressure, chills, and chest pain. These symptoms are generally temporary and often respond to a decrease in infusion rate. In addition, some patients develop antibodies, which have been associated in rare cases with symptoms similar to those of patients with systemic lupus erythematosus. These symptoms were also temporary. Another side effect is increased risk of infections. Fatal cases of tuberculosis have been reported following infliximab therapy. Another potential side effect is an increased risk of lymphoma. Its occurrence remains controversial. 

Rheumatoid arthritis Single-center experience 32 weeks Leflunomide 100 mg/day for 3 days, then 20 mg/day plus infliximab 3 mg/kg at 2, 4, 8, 16, and 24 weeks (n = 20) 11/20 withdrawn (four infliximab infusion reactions, one Stevens-Johnson syndrome) the other patients achieved American College of Rheumatology 20 and 70 response rates in >80% and 46% (17)... 

Infliximab is used for moderate to severe active Crohn s disease in patients failing immunosuppressive therapy, in those who are corticosteroid dependent, and for treatment of fistulizing disease. A single, 5 mg/kg infusion is effective when given every day for 8 weeks. Additional doses at 2 and 6 weeks following the initial dose results in higher response rates. Adalimumab is effective in 54% of patients with moderate to severe Crohn s disease who have lost response to infliximab. The typical dosage is 160 mg subcutaneously initially, followed by 80 mg subcutaneously at week 2, with subsequent doses of 40 mg subcutaneously every other week thereafter. 

Reactivation of latent tuberculosis is a major concern with infliximab (SEDA-26, 402), and accounts for about one-third of infections in these patients. According to data from the manufacturers, 130 cases of active tuberculosis were notified up to October 2001. Many of the cases were disseminated or extrapulmonary tuberculosis, and several patients died. Several case reports have provided detailed information in at least seven other patients, including three who developed miliary tuberculosis and one who developed Mycobacterium tuberculosis enteritis (44-48). A detailed analysis of 70 cases of tuberculosis reported to the FDA has been published (49). Two-thirds of the cases were noted after three or fewer infusions and 57% of the patients had extrapulmonary disease. There were 64 cases from countries with a low incidence of tuberculosis. From these reports and the number of patients treated with infliximab, the estimated rate of tuberculosis in patients with rheumatoid arthritis treated with infliximab was four times higher than the background rate. Patients with evidence of active infection should not receive infliximab until the infection is under control all should be screened for tuberculosis before starting infliximab (50). From these and other data it has been estimated that the risk of tuberculosis in the first year of infliximab treatment is 0.035 in US citizens and 0.2% in non-US citizens. Further investigations, such as a chest X-ray and a Mantoux test, and prophylactic treatment with isoniazid, will show whether the incidence can be reduced in patients taking anti-TNF treatment (51). 

Infliximab This humanized MAb has a mechanism similar to that of etanercept since it is targeted against TNF-a. Infliximab induces remissions in treatment-resistant Crohn s disease, but long-term efficacy has not been estabbshed. In combination with methotrexate, infliximab improves symptoms in patients with rheumatoid arthritis. It also is effective in the treatment of inflammatory bowel disease. Infusion reactions and an increased rate of infection may occur. 

Allergic reactions to aU three agents have been described. For etanercept, injection site reactions can occur in up to 20% of patients (287). Some patients develop recall reactions in areas of prior injections (288). More severe reactions, including anaphylactoid reactions, have been reported with infliximab. Up to 20% of patients with infliximab develop infusion reactions. The rate is lower for those patients receiving a concomitant cytotoxic drug such as MTX (289). Infliximab is a chimeric monoclonal antibody. Patients with infusion reactions to infliximab have been successfully treated with the humanized monoclonal antibody adalimumab (278,290). 

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