Infliximab

Infliximab is a chimeric monoclonal antibody that binds tumor necrosis factor-alpha (TNF-α), a key cytokine in inflammatory processes. It is a biologic medicine used to treat several autoimmune diseases and is marketed as Remicade, with several biosimilars available in many regions.

Mechanism of action and pharmacology: Infliximab neutralizes both soluble and transmembrane TNF-α, reducing inflammatory signaling. It can also mediate immune mechanisms such as antibody-dependent cellular cytotoxicity and complement activation, contributing to its therapeutic effects.

Medical uses: Infliximab is approved for Crohn’s disease and ulcerative colitis, as well as rheumatologic conditions including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, and for plaque psoriasis. It may be used in other immune-mediated diseases under specialist care, depending on regional approvals and clinical guidelines.

Administration and dosing: Infliximab is given by intravenous infusion. Dosing regimens vary by condition: for Crohn’s disease and ulcerative colitis, typical initial dosing is 5 mg/kg at weeks 0, 2, and 6, then every 8 weeks; for rheumatoid arthritis, 3 mg/kg at weeks 0, 2, and 6, then every 8 weeks, with adjustments possible based on response. Infusions are commonly conducted over several hours, and premedication may be used to reduce infusion-related reactions.

Safety and monitoring: Infliximab carries a risk of serious infections, including tuberculosis and hepatitis B reactivation, and is not advised during active infections. It can worsen heart failure and may be associated with demyelinating disorders or certain malignancies. Patients should be screened for TB and hepatitis B before starting and monitored regularly for infections, liver function, and blood counts. Concomitant immunosuppressants may increase infection risk, and vaccines should be managed according to guidelines.