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Inflammatory Bowel Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Infliximab: Infliximab is a tumor necrosis factor (TNF)-alpha inhibitor approved for use in patients with IBD [71–73]. Several studies and a meta-analysis have documented the safety of infliximab in pregnancy and have shown no increased risk of congenital anomalies, or other adverse pregnancy or postnatal outcomes [74–82]. There are concerns regarding increased drug transfer across the placenta in the third trimester and high newborn drug levels [83, 84]. Cord blood concentrations of infliximab and adalimumab are significantly higher than maternal levels and they remain detectable for up to 1 year [48]. Elevated newborn drug levels may in theory increase the neonatal infectious complications or response to vaccines, although this has not been demonstrated clinically [82, 85, 86]. This concern has led to a recommendation to avoid live vaccines for the first 6 months of life [48, 78].
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Biologic therapy has opened a new era in the treatment of IBD. All three biologic agents including infliximab, adalimumab, and certolizumab are pregnancy category B. These agents inhibit the activity of tumor necrosis factor and are used for induction and maintenance of remission in IBD patients. Data on the safety of infliximab in pregnancy are limited; however, no maternal toxicity, embryotoxicity, or teratogenicity to infliximab has been observed. The two largest studies are the Crohn’s Therapy, Resource, Evaluation, and Assessment Tool (TREAT) registry and the Infliximab Safety Database (105,106). The TREAT registry is a prospective, multicenter study of CD patients. Of more than 6200 patients enrolled, 117 of 168 pregnancies were exposed to infliximab. No fetal malformations were seen. Miscarriage and neonatal complication rates were not statistically significant between the infliximab-exposed and unexposed group (105). The Infliximab Safety Database is a retrospective database that records voluntary adverse event reports associated with infliximab use. The expected versus observed outcomes among women exposed to infliximab were reported no different than those of the general population (106). In a recent case series, infliximab remained undetectable in breast milk while maternal levels remained in the therapeutic range (107). Case reports have also described successful use of adalimumab in women with CD and pregnancy (108–110).
Toxic Megacolon in Crohn’s Colitis
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
After initial treatment with intravenous steroids, and in this case, antibiotics and antivirals, patients are assessed for disease progression. Disease progression warrants a trial of biologic therapy (monoclonal antibodies) in the absence of hemodynamic instability. Infliximab (Remicade) has the fastest onset of action with rapid recovery should the colitis be sensitive to this drug. Although the pharmaceutical advice from Janssen Immunology (J&J) reveals that it crosses the placenta and poses a theoretical risk of infections in the newborn child for six months, clinical evidence suggests that infliximab is relatively safe in pregnancy to both mother and fetus/newborn [4]. However, in the absence of a response to the first dose of infliximab, surgery should be considered urgently.
The Complete Success in Refractory Mooren’s Ulcer Treated with Infliximab
Published in Ocular Immunology and Inflammation, 2023
Ayşe İdil Çakmak, Yonca Akova, Nilgün Yıldırım
The common infliximab-related adverse effects are usually well-tolerated mild skin reactions, including flushing, urticaria, pruritus, and rash, which seldom require the discontinuation of therapy.10 However, serious systemic adverse effects such as hypersensitivity reactions (e.g., tachycardia, dyspnea and laryngeal spasm), hematological abnormalities (e.g., pancytopenia and bone marrow toxicity) and neuropathies (e.g., optic neuritis, demyelinating disorders, asceptic meningitis and Guillain–Barre syndrome) have been reported.10–16 Bacterial, viral and fungal infections have also been observed in patients treated with infliximab, and reactivation of latent tuberculosis infection rather than new infection have been reported.10,17,18 More importantly, the development of infliximab-associated lymphoma and nonlymphoma malignancies (such as carcinomas of the breast, uterus-cervix, prostate, and colon-rectum) has been reported.10–19 The patients in the presented cases did not experience any systemic or local adverse effects caused by infliximab.
Efficacy of Infliximab in Disease Control of Refractory Orbital Myositis
Published in Ocular Immunology and Inflammation, 2023
Amgad El Nokrashy, Sue Lightman, Oren Tomkins-Netzer
Recently, biological agents have been considered as an alternative to corticosteroids for treatment of OM. Infliximab is a chimeric monoclonal antibody that is agreed by the Food and Drug Administration (FDA) for the treatment of some autoinflammatory diseases. It acts by binding to the cytokine tumor necrosis factor- α (TNF-α) which plays a vital role in the autoimmune cascade. As a result, infliximab inhibits the effect of TNF-α on the release of inflammatory mediators.17 The efficacy of infliximab has been reported in the treatment of patients with systemic myositis with obvious and sustained improvement of their muscle functions allowing them to become fully self-caring,18,19 proposing that biological treatment may be an effective therapy for OM.18,20,21
Response to the Second TNF-α Inhibitor (Adalimumab or Infliximab) after Failing the First One in Refractory Idiopathic Inflammatory Retinal Vascular Leakage
Published in Ocular Immunology and Inflammation, 2022
Arash Maleki, Cristina M Garcia, Soheila Asgari, Ambika Manhapra, Charles Stephen Foster
The side effects of adalimumab in both groups included increased respiratory infections in one patient, painful injections in one patient, injection site reaction in one patient, fatigue and weakness in one patient, sinus infection and ear infection in one patient, and skin rash in one patient. The side effects of infliximab included skin rash in one patient, gastrointestinal symptoms in one patient, drug-induced lupus in one patient, pneumonia and deep vein thrombosis in one patient, and infusion reaction [anaphylactoid reaction: moderate immediate infusion reaction (chest tightness, urticarial, hypertension, and fever)] in one patient. The latter patient was treated successfully with discontinuing infliximab infusion a combination of oral acetaminophen, intramuscular anti-histamine, and intravenous corticosteroids.