From the Guidelines
Infliximab can cause several musculoskeletal side effects, including joint pain, muscle pain, and back pain, affecting up to 40% of patients, as reported in clinical trials 1. The most common musculoskeletal side effects of infliximab include:
- Joint pain
- Muscle pain
- Back pain These side effects can occur due to the immune-modulating effects of infliximab, a TNF-alpha inhibitor. More severe inflammatory adverse events, such as arthritis, polymyalgia-like syndromes, and myositis, can also occur, although less frequently 1.
Key Considerations
- Musculoskeletal symptoms can affect patients' quality of life and daily activities
- Inflammatory markers are usually elevated in patients with infliximab-induced arthritis, helping to differentiate it from other rheumatic syndromes 1
- Treatment may involve corticosteroids, synthetic or biologic disease-modifying antirheumatic drugs, and intra-articular corticosteroid injections 1
- Patients with pre-existing autoimmune rheumatic conditions may be at higher risk of toxicity and require close monitoring and multidisciplinary management 1
- Myositis is a rare but potentially severe and fatal complication of infliximab, requiring urgent treatment with high-dose corticosteroids and possibly other immunosuppressants 1
From the FDA Drug Label
Musculoskeletal system disorders Arthralgia 7% 8%
The most relevant side effect of infliximab related to the musculoskeletal system is arthralgia, which was reported in 7% to 8% of patients.
From the Research
Side Effects of Infliximab on Musculoskeletal System
- Infliximab is a chimeric monoclonal antibody used to treat rheumatoid arthritis (RA) and other inflammatory diseases 2, 3.
- The most commonly reported adverse events with infliximab are headache, nausea, upper respiratory tract infection, and infusion-related reactions 3.
- Serious events, including disseminated infection and new or recurrent malignancies, have been reported in patients treated with infliximab, although the exact relationship between infliximab and these events is unknown 3.
- Infliximab has been associated with the development of drug-induced lupus in some patients with RA 3.
- About 10% of patients may develop antibodies to infliximab, although the clinical significance of these is presently unknown 3.
- Long-term safety data on infliximab are mainly available from studies in patients with RA, and it is suggested that side effects of infliximab may be fewer in ankylosing spondylitis compared to RA 4.
Efficacy of Infliximab in Musculoskeletal Diseases
- Infliximab has been shown to be highly efficacious in the treatment of ankylosing spondylitis (AS), with good clinical outcomes after 3 years of treatment 4.
- The combination of methotrexate and infliximab therapy has been shown to be more effective than methotrexate monotherapy in early RA, with greater protection against joint damage and physical disability 2.
- Infliximab has been associated with a reduced therapeutic response over time, suggestive of acquired drug resistance, compared to other anti-TNF agents 5.
Comparison with Other Anti-TNF Agents
- Infliximab has been compared to other anti-TNF agents, such as etanercept and adalimumab, in terms of efficacy and safety 3, 5.
- Infliximab has been associated with a higher risk of requiring intensification of DMARD co-therapy and a significant dose escalation over time compared to other anti-TNF agents 5.