Clinical Pearls for Remicade (Infliximab):

• Indications: Remicade is approved for treating several inflammatory conditions including Crohn's disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.

• Mechanism of Action: Infliximab works by neutralizing tumor necrosis factor-alpha (TNF-α), a cytokine involved in systemic inflammation, thereby reducing the inflammatory response which is a hallmark of autoimmune disorders.

• Pre-Treatment Screening: Prior to initiating therapy, screen for latent tuberculosis and perform tests for hepatitis B virus due to potential reactivation. Continue to monitor patients throughout treatment for signs of active TB and other infections.

• Dosing and Administration: Infliximab is administered by intravenous infusion, typically at 0, 2, and 6 weeks as an induction phase, followed by a maintenance phase every 8 weeks. Dosing adjustments or interval changes may be necessary based on patient response and tolerability.

• Risk of Infusion Reactions: Administer pre-medication (antihistamines, corticosteroids, or acetaminophen) to reduce the risk of acute infusion reactions. Monitor patients during and after infusion for any signs of hypersensitivity.

• Handling and Preparation: Remicade must be reconstituted and diluted before use, adhering strictly to aseptic techniques as it does not contain any preservatives. Infusions should be prepared and used within 3 hours of reconstitution.

• Monitoring for Immunosuppressive Effects: Regularly assess patients for signs of immunosuppression, including opportunistic infections. Educational emphasis on reporting any symptoms suggestive of infection is key.

• Management of Side Effects: Closely monitor for symptoms of heart failure, as infliximab can exacerbate HF symptoms. Patients with pre-existing HF should be treated with caution, and infliximab should be discontinued if new onset or worsening symptoms occur.

• Patient Education and Compliance: Inform patients about the importance of completing the full infusion schedule and not missing doses to prevent loss of response due to antibody formation against infliximab.

• Cancer Surveillance: Due to the increased risk of lymphoma and other cancers, maintain vigilant long-term surveillance for the development of malignancies in patients treated with infliximab.