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Anti-TNF Monoclonal Antibody Pregnancy: Compatible in first/second trimester; avoid third trimester (neonatal immune suppression at birth; defer live vaccines in infant for 6 months)

Infliximab

Brand names: Remicade, Inflectra (biosimilar)

Adult dose

Dose: Induction: 5 mg/kg IV at 0, 2, 6 weeks. Maintenance: 5 mg/kg IV every 8 weeks. May increase to 10 mg/kg every 8 weeks in partial responders.
Route: IV infusion (over 2 hours)
Frequency: Induction at 0, 2, 6 weeks; then every 8 weeks maintenance
Max: 10 mg/kg per dose
For moderate-severe Crohn's, ulcerative colitis, rheumatoid arthritis, psoriasis, ankylosing spondylitis. Screen for TB, viral hepatitis, and varicella before starting.

Paediatric dose

Dose: 5 mg/kg
Route: IV infusion (over 2 hours)
Frequency: 0, 2, 6 weeks then every 8 weeks
Max: 5 mg/kg per dose (may escalate to 10 mg/kg in partial responders)
Concentration: 5 mg/ml
BNF for Children: 5 mg/kg IV at 0, 2, 6 weeks (induction), then every 8 weeks (maintenance). Licensed ≥6 years for moderate-severe Crohn's/UC. Pre-medicate if prior infusion reactions. TB/hepatitis B screen before starting. Source: BNF for Children 2024; ECCO Paediatric IBD Guidelines

Dose adjustments

Renal

No dose adjustment required

Hepatic

No specific dose adjustment; avoid in active hepatitis B

Paediatric weight-based calculator

BNF for Children: 5 mg/kg IV at 0, 2, 6 weeks (induction), then every 8 weeks (maintenance). Licensed ≥6 years for moderate-severe Crohn's/UC. Pre-medicate if prior infusion reactions. TB/hepatitis B screen before starting. Source: BNF for Children 2024; ECCO Paediatric IBD Guidelines

Clinical pearls

  • Screen for latent TB (IGRA/Mantoux) and viral hepatitis B/C before starting — treat latent TB first
  • Combination with immunomodulator (azathioprine/methotrexate) reduces antibody formation and improves long-term efficacy
  • Monitor drug trough levels and anti-drug antibodies to guide dose optimisation
  • Report to BSRBR or BIOBADASER registry for ongoing pharmacovigilance

Contraindications

  • Active TB or serious infection
  • Active moderate-severe heart failure (NYHA III–IV)
  • Active hepatitis B (reactivation risk)
  • Prior malignancy within 5 years (relative)
  • Previous demyelinating disease

Side effects

  • Infusion reactions (acute: fever, chills, flushing; delayed: serum sickness-like)
  • Serious infections (TB reactivation, fungal, opportunistic)
  • Malignancy risk (lymphoma, NMSC)
  • Demyelinating disease (rare)
  • Anti-drug antibodies (reduced efficacy)
  • Lupus-like syndrome

Interactions

  • Live vaccines — contraindicated during therapy
  • Anakinra — increased infection risk (avoid combination)
  • Abatacept — increased serious infection risk (avoid)
  • Methotrexate — reduces anti-drug antibody formation (often co-prescribed in IBD/RA)

Monitoring

  • TB screening at baseline and annually
  • LFTs and FBC
  • Drug trough levels and anti-drug antibodies
  • Signs of infection
  • Annual skin cancer surveillance (NMSC risk)

Reference: BNFc; BNF; NICE TA187; ECCO IBD Guidelines 2021. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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