Toxicity infliximab

Patients with fulminant disease are treated similarly, although infliximab is not indicated for this population. Patients with fulminant UC should be assessed for signs of significant systemic toxicity or colonic dilation, which may require earlier surgical intervention. 

Concurrent administration of etanercept (another TNF -blocking agent) and anakinra (an interleukin-1 antagonist) has been associated with an increased risk of serious infections, and increased risk of neutropenia and no additional benefit compared with these medicinal products alone. Other TNF -blocking agents (including infliximab) used in combination with anakinra also may result in similar toxicities. 

The most common adverse effects of infliximab are headaches, fever, chills, fatigue, diarrhea, pharyngitis, upper respiratory and urinary tract infections, and hypersensitivity reactions (urticaria, dyspnea, and hypotension). Infliximab has been also associated with infections and lymphoproliferative disorders. It is not associated with end-organ toxicity, and blood counts, liver enzyme levels, kidney function, and complement values can be expected to remain normal during treatment. This gives it a major advantage over other systemic psoriasis treatments. 

A 31-year-old man developed toxic epidermal necrolysis after taking etoricoxib 60mg/day for 3 weeks for pain associated with disk herniation he was successfully treated with infliximab [33 ]. 

Kreft B, Wohlrab J, Bramsiepe I, Eismann R, Winkler M, Marsch WC. Etor-icoxib-induced toxic epidermal necrolysis successful treatment with infliximab. J Dermatol 2010 37(10) 904-6. 

Liver A 38-year-old woman with rheumatoid arthritis developed a toxic hepatitis while taking infliximab [50 ]. 

Carlsen KM, Riis L, Madsen OR. Toxic hepatitis induced by infliximab in a patient with rheumatoid arthritis with no relapse after switching to etanercept. Clin Rheumatol 2009 28(8) 1001-3. 

Like cetuximab, infliximab is a monse-hnman chimeric IgGlK mAb. With specificity for TNF, the antibody is used to treat autoimmune diseases snch as Crohn s disease and rheumatoid arthritis (Table 11.1) and there are a few reports of it indneing rapid recovery of lesions in several cases of toxic epidermal necrolysis (Sect. 3.63.1). A variety of reactions, both systemic and cutaneons, have been reported following administration of infliximab. These inclnde macnlopapular rashes, nrticaria, psoriasis, flare-np of atopic dermatitis. 

Systemic corticosteroids are required for cases of anterior uveits that are refractory to eyedrops and for cases of intermediate and posterior uveitis because eyedrops cannot adequately penetrate deep into the eye. The initial corticosteroid dose is 40 mg/day of prednisone equivalent, which is adjusted according to the response to therapy. Corticosteroid-sparing alternatives are often considered for sarcoid uveitis because of the toxicity of systemic corticosteroids. Methotrexate (21), azathioprine (22), leflunomide (23), and infliximab (24) have been used for this purpose. 

AAV. However, all TNF-a inhibitors have potential serious toxicities including opportunistic infections lymphoproliferative and sohd malignancies (20,158) induction of autoimmune disorders, vasculitis, or interstitial lung diseases (186). Placebo-controlled trials are necessary to ascertain the role of infliximab or other TNF-ot inhibitors for WG or AAV. 

Skin A 32-year-old woman who developed toxic epidermal necrolysis while on sulfasalazine was treated with infliximab on the basis that TNFa antagonists have sometimes proved to be a successful treatment for this still-to-be-xmderstood toxidermia. The mAb triggered erosive lichen planus involving the mouth and vulva [148 ]. A discoid lupus erythematosis-like eruption associated with infliximab was recently diagnosed in a rheumatoid arthritis patient [149 ]. Although known, this condition has been rarely reported in patients taking infliximab. 

Worsnop F, Wee J, Natkunarajah J, Moosa Y, Marsden R. Reaction to biological drugs infliximab for the treatment of toxic epidermal necrolysis subsequently triggering lichen planus. Qin Exp Dermatol 2012 37(8) 879-81. 

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