Side effects of infliximab

Unwanted side-effects in trials have been found as follows:

• Infections 32% vs 22% on placebo
• Infusion related effects - fever, chills, urticaria, chest pain, hypo/hypertension, dyspnoea) - 19% vs 8% - these improved on pausing or slowing the infusion
• Other side effects included headaches, vertigo, dizziness, flushing, GI effects, liver abnormalities and fatigue

Delayed hypersensitivity reactions have been reported in Crohn's disease patients restarted on infliximab 2-4 years after an initial course.

In a study pf 428 patients given infliximab 53-68% developed antinuclear antibodies (vs 26% on placebo plus methotrexate), and 7-11% developed anti dsDNA antibodies.

A lupus-like syndrome has been described with infliximab and if this occurs the drug should be discontinued.

Risk of malignancy:

• a systematic review that there e is evidence of an increased risk of serious infections and a dose-dependent increased risk of malignancies in patients with rheumatoid arthritis treated with anti-TNF antibody therapy (1)

Reference:

1. Bongartz T et al. There is evidence of an increased risk of serious infections and a dose-dependent increased risk of malignancies in patients with rheumatoid arthritis treated with anti-TNF antibody therapy. JAMA. 2006 May 17;295(19):2275-85.