From the Guidelines
Remicade (infliximab) can cause adverse reactions in up to 20% of patients, ranging from mild to severe, including infusion reactions, infections, and allergic reactions, and management depends on the severity of the reaction. According to the British Association of Dermatologists guidelines 1, infusion reactions occurring during or within 1–2 h of treatment can result in anaphylactic shock, and management may involve slowing or temporarily interrupting the infusion rate, and providing symptomatic treatment. More severe reactions may require discontinuation of infliximab, but do not necessarily preclude treatment with other anti-TNF agents.
Some key points to consider when managing adverse reactions to Remicade include:
- Infusion-related reactions can occur in 3–22% of patients, including rare cases of anaphylactic shock and delayed hypersensitivity 1
- Antibodies to infliximab can develop, increasing the risk of immunological reactions and reducing the efficacy of therapy 1
- Hepatotoxicity, including elevation in liver transaminases, is a recognized side effect of infliximab therapy, and rare cases of severe hepatitis and acute liver failure have been reported 1
- Patients should be encouraged to participate in national cancer screening programs, and biologic therapy should be avoided in patients with a current or recent past history of malignancy, unless the malignancy has been diagnosed and treated more than 5 years previously 1
It is essential to monitor patients closely for signs of adverse reactions, and to adjust treatment accordingly, as the risk of severe reactions, including anaphylaxis and hepatotoxicity, necessitates careful management and consideration of alternative treatments. If you experience symptoms like fever, persistent cough, shortness of breath, unusual bleeding, yellowing of skin or eyes, or severe rash after Remicade treatment, seek immediate medical attention, as these may be indicative of a serious adverse reaction 1.
From the Research
Adverse Reactions to Remicade
- Infliximab, also known as Remicade, is a chimeric monoclonal antibody that can lead to infusion reactions in 3-22% of patients with psoriasis treated with infliximab 2.
- Most infusion reactions are mild or moderate, but some can be severe and lead to discontinuation of treatment 2.
Management of Infusion Reactions
- Proper care and prevention of infusion reactions can diminish the need to discontinue treatment with infliximab 2.
- In cases of anaphylaxis, a potentially life-threatening multisystem allergic reaction, intramuscular epinephrine is the immediate treatment of all patients 3, 4, 5.
- Antihistamines and corticosteroids are second-line medications and should not be given in lieu of, or prior to, epinephrine 3, 6, 5.
Treatment of Anaphylaxis
- Epinephrine remains the drug of choice and should initially be administered intramuscularly, into the anterolateral thigh, as soon as the diagnosis is suspected 3, 4, 5.
- For patients unresponsive to repeated intramuscular injections, a continuous infusion of epinephrine should be started, along with fluid resuscitation 3, 4.
- Corticosteroids may be beneficial in reducing the length of hospital stay, but there is no compelling evidence to support or oppose their use in emergency treatment of anaphylaxis 6.