Real-World Effectiveness of Infliximab: An Updated Review for Pharmacists
Abstract
Background: Infliximab, a chimeric monoclonal antibody targeting tumor necrosis factor-alpha (TNF-α), is widely used for immune-mediated inflammatory disorders. Its clinical effectiveness is influenced by immunogenicity, pharmacokinetics, and safety considerations.
Aim: This review aims to summarize updated evidence on infliximab’s real-world effectiveness, approved indications, off-label uses, mechanism of action, pharmacokinetics, administration, adverse effects, and monitoring strategies for pharmacists.
Methods: A comprehensive literature review was conducted, integrating regulatory guidelines, clinical trial data, and real-world practice insights to evaluate infliximab’s therapeutic role and safety profile.
Results: Infliximab is FDA-approved for conditions including Crohn disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis, with weight-based intravenous dosing schedules. Off-label applications extend to Behçet disease, pyoderma gangrenosum, and refractory sarcoidosis. Its mechanism involves TNF-α neutralization, reducing cytokine-driven inflammation. Pharmacokinetics reveal a prolonged half-life (7–12 days), supporting intermittent dosing. Adverse effects include infusion reactions, hepatotoxicity, infection risk (notably tuberculosis and hepatitis B reactivation), and rare neurologic or autoimmune phenomena. Boxed warnings highlight infection and malignancy risks. Monitoring protocols emphasize TB and hepatitis screening, cardiac assessment, and vaccination planning.
Conclusion: Infliximab remains a cornerstone biologic therapy, offering substantial clinical benefit when used with rigorous screening, structured monitoring, and interprofessional collaboration. Pharmacists play a pivotal role in optimizing dosing, preventing drug interactions, and educating patients to enhance adherence and safety.
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Authors
Copyright (c) 2025 Abdulelah Hassan Ayashi Majrashi, Emad Ali Ayoub Hakami, Khaled Alhamidi Alanazi, Intisar Awadh Alanazi, Al Anoud Abdullah Raheel Al Anzi, Ahmed Abubakr Ahmed Bajbair, Amirah Mousa Ali Mokali, Dhaifallah Mohammed Moraya, Khalid Rashed Almutiri, Fahad Jaber Salem Allughbi, Abdulmajeed Fahad Eid Almuqati, Rayan Faisal Falah Al Otaibi
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