Infliximab is an antibody to tumor necrosis factor alpha (TNF-alpha). It can be helpful for patients with a variety of autoimmune diseases, but it may be associated with severe complications in certain patients.
Contraindications for therapy with anti-TNF-alpha:
(1) active infection
(2) risk factors for infection (see below)
(3) multiple sclerosis
(4) systemic lupus erythematosus
(5) malignancy (with certain exceptions, listed below)
(6) if female of childbearing age, breastfeeding or pregnancy
(7) if female of childbearing age, refusal to use effective contraception if able to have children
Factors associated with a high risk for infection:
(1) history of, or risk factors for, tuberculosis
(2) septic arthritis of a native joint within the past year
(3) septic arthritis of a prosthetic joint within the past year if removed
(4) septic arthritis of a prosthetic joint that has been left in situ (not removed)
(5) presence of an indwelling urinary catheter
(6) recurrent or persistent pulmonary infections
(7) chronic leg ulcer
where:
• I would imagine that certain deep fungal infections like histoplasmosis might also be a contraindication.
Exceptions to contraindication for malignancy:
(1) basal cell carcinoma of the skin
(2) treatment > 10 years ago with high probability of complete cure
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