Infliximab

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient infliximab is an antibody that can intercept a central inflammatory messenger substance in the body (tumor necrosis factor alpha = TNF) and thus has an anti-inflammatory effect. It is used in severe autoimmune diseases and, since it is a biotechnologically produced protein, it must be administered directly as an infusion. Here you can read everything you need to know about the effects and use of infliximab, side effects and interactions.

This is how infliximab works

In autoimmune diseases, the immune system falsely attacks the body's own structures. Organ systems such as the intestines (in Crohn's disease and ulcerative colitis), the joints (in rheumatoid arthritis) or the skin (in psoriasis) are usually affected. In the case of an autoimmune disease, the immune system is not generally overactive, but rather shows a kind of malfunction in relation to a type of tissue - the immune cells (especially white blood cells) against it. Among other things, scavenger cells (macrophages) - a group of white blood cells - release inflammation-promoting substances such as tumor necrosis factor alpha (TNF). This small protein signals to other white blood cells that an inflammatory process is taking place and that the affected area should be supplied with more blood. It swells and also hurts. Other inflammatory messengers put the whole body on the alert, making the patient feel sick and weak.

Antibodies like infliximab are given directly into the bloodstream and intercept tumor necrosis factor. One infusion is sufficient to bind the newly formed TNF from the blood over several weeks and to be broken down with it. However, since infliximab is a mixed protein of human and animal origin (mouse), there may also be intolerances. Because of this, but also because of the high therapy costs, infliximab is only used when other active drugs such as glucocorticoids (“cortisone”) or methotrexate (MTX) do not work or work only inadequately.

Infliximab uptake, breakdown, and excretion

After infliximab is infused, the active substance remains in the bloodstream. There it unfolds its effect and is slowly broken down - like other proteins in the blood. About eight to ten days after the infusion, the blood level of the active ingredient has fallen by half. In studies, infliximab antibodies could still be detected in the blood eight weeks after administration.

When is infliximab used?

The active ingredient infliximab is used to treat various autoimmune diseases. It is approved for the therapy of:

• rheumatoid arthritis and psoriatic arthritis (inflammatory joint diseases)
• Crohn's disease and ulcerative colitis (inflammatory bowel disease)

Treatment with infliximab is usually long-term, but the active ingredient only needs to be administered by the doctor at intervals of several weeks.

This is how infliximab is used

The active ingredient infliximab can only be administered as an infusion. A venous access is placed and the antibody is injected directly into the bloodstream over a period of two hours. The patient must then be monitored for one to two hours if acute intolerance reactions to infliximab occur. At the start of treatment, smaller amounts of active ingredient are administered at shorter intervals of two weeks in order to make infliximab more tolerable. After a few months, larger amounts of active ingredient can be given at longer intervals (six to eight weeks).

Additional active ingredients are usually taken during therapy by the patient himself. Infliximab is often combined with methotrexate, non-steroidal anti-inflammatory drugs (naproxen, piroxicam, diclofenac) or glucocorticoids ("cortisone") in order to increase the effectiveness of the therapy.

What are the side effects of infliximab?

Since the active ingredient suppresses the immune system, infliximab side effects such as viral infections, respiratory infections and sinus infections are very common. Headaches, abdominal pain, nausea, pain and reactions at the infusion site are also very common.

One in ten to one hundred people treated also shows undesirable effects such as chest pain, fever, water retention, urinary tract infections and other bacterial infections, psoriasis, liver dysfunction, diarrhea, constipation, indigestion, bleeding in the gastrointestinal tract, nosebleeds, shortness of breath, lower or higher Blood pressure, palpitations and palpitations, conjunctivitis, dizziness, anemia and changes in the blood count.

What should be considered when treating with infliximab?

In general, antibodies have a comparatively lower potential for interaction. Infliximab should not be combined with live vaccines, as the immune reaction to the vaccine does not take place sufficiently and therefore no vaccination protection is guaranteed.

The simultaneous use of other antibodies that act against TNF (such as adalimumab and etanercept) is not therapeutically useful.

Infliximab should not be used during pregnancy and breastfeeding as insufficient data on safety are available. The active ingredient enters the child's bloodstream through the placenta and can increase the susceptibility to infections.

Children from the age of six may be treated with infliximab in a correspondingly reduced dose.

How to get infliximab medication

The active ingredient infliximab is only administered by the doctor or medical staff. In Germany it is classified as requiring a prescription.

How long has infliximab been known?

The antibody infliximab was developed at New York University in 1989 and tested in the following years. As early as 1998, the US health authority (FDA) granted approval for the active ingredient in the USA. A year later, drugs with the active ingredient infliximab were also approved in Germany.

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