Infliximab

Remicade® Infliximab IFX (MSD)

Biosimilars approved in Switzerland: Inflectra® (Pfizer), Remsima® (iQone Healthcare).

Chimeric monoclonal IgG1 antibody that binds to soluble and membrane-bound TNF-α.

Plaque psoriasis in adults (maximum treatment duration of one year) with ETA, IFX, ADA; also psoriatic arthritis; for ETA: indicated for patients aged 6 years and older.

Yes (Infliximab: if previous treatment with a TNF inhibitor has failed).

Severe plaque psoriasis that has shown an inadequate response to treatment with cyclosporine, MTX, acitretin, UVB, or PUVA, or in cases where there is a contraindication or intolerance to such therapies.

Differential blood count, liver enzymes, creatinine, urinalysis, pregnancy test, CRP, screening for HBV, HCV, HIV, and TB (optional, including chest X-ray)

Differential blood count, liver enzymes, and CRP.

After 2 and 6 weeks, and then before each infusion.

IV infusion over 2 hours.

5 mg/kg in weeks 0, 2, and 6. Then every 8 weeks.

Combination with MTX may prolong drug survival by reducing antibody formation.

Week 10: 75–80%

Week 24: 69.2%

Week 10: 49.5%

Week 24: 50.6%

Paradoxical psoriasis may develop while taking TNF-α inhibitors. Close monitoring is recommended if infections occur. Live vaccines are not recommended during therapy.

Remicade® 5 mg/kg: 16,604 (21,348)

Inflectra® 5 mg/kg: 17,556 (22,572)

Remsima® 5 mg/kg: 14,980 (19,260)

Schedule elective, major surgeries between two infliximab infusions; Caution: there may be a higher risk of a reaction to the infusion when resuming treatment after a break (monitoring for 1 hour after the infusion is generally recommended).

PASI (use PrecisePASI for greater accuracy when PASI < 10), BSA, and DLQI after 10 and 24 weeks.

19.5–51.5%, association with clinical response.

Absolute contraindications: NYHA Class III–IV heart failure, active infections, live vaccines, malignant tumours within the past 5 years (except for treated epithelial tumours or cervical dysplasia), demyelinating diseases, unexplained neurological conditions (including family history). Pregnancy and breastfeeding. Active HBV or TB infection.

Relative contraindications: systemic lupus erythematosus. For IFX: allergies to murine antibodies, pregnancy in the first and second trimesters, paradoxical psoriasis (class effect)—switch to a different class of biologics.

Local reactions at the injection site (monitoring 1 hour after infusion), rarely angioedema, vertigo, headache, fever, fatigue, bacterial and viral infections, cytopenia, elevated liver enzymes, lupus-like syndromes, neurological symptoms including paresthesias, multiple sclerosis, facial nerve palsy, lymphomas, solid organ tumors, squamous cell carcinomas, malignant melanomas, paradoxical psoriasis.

Yes, with concurrent HBV therapy (started 3 months before anti-TNF therapy). HBV DNA and liver function tests every 2 months, in consultation with gastroenterology.

Best evidence is available for etanercept.

Yes, monitoring of liver function and HCV-RNA; treatment in collaboration with gastroenterology; best evidence is available for etanercept.

Possible; decision depends on the individual case, in consultation with infectious disease specialists.

Combination with anakinra and abatacept is not recommended (due to an increased risk of infection without any increase in efficacy in studies with other TNF-α inhibitors; no specific data available for Cimzia®).

TB prophylaxis with isoniazid, rifampicin, or isoniazid + rifampicin for at least 1 month before starting treatment.

Slightly elevated for skin carcinomas, but not for other tumours.