Infliximab’s benefits as an anti-inflammatory agent are significant in rheumatoid arthritis and Crohn’s disease. In short-term trials and now a longer-term (one-year) evaluation, infliximab has proven beneficial in treating RA by decreasing the signs and symptoms of the disease as well as halting the progression of joint damage. Crohn’s disease participants in the trials reviewed benefited from a decrease in the number and severity of fistulas, an improvement in CDAI score of at least 70 points, with about one-third of participants experiencing a remission of their disease.

As explored by Reimold, infliximab may be useful in other inflammatory diseases as well. Further research into adult Still’s disease, ankylosing spondylitis, psoriasis, and uveitis should provide more information as to proper dosing and mechanisms. Additional trials are warranted in other inflammatory conditions that may benefit from infliximab therapy.

The potential for adverse effects related to infliximab include an increased risk of infection. TNF-α blockers, as a class, act as general immunosuppressants which can result in opportunistic infections similar to those seen in other immunosuppressed states such as HIV infection or treated transplant patients. In addition to those risks experienced with any injectable therapy, an increased rate of tuberculosis (TB) has been seen in patients receiving infliximab. As of March 2001, infliximab has been given to approximately 147,000 patients with 70 cases of TB reported. A lower incidence (17) was seen in the subgroup of 121,000 who were treated in the United States. While the majority of patients were being treated with infliximab for Crohn’s disease, most (47/70) of the TB cases occurred in patients receiving therapy for RA (it is postulated that chronic dosing used in RA may increase risk of infection if exposed to TB). 12 of the 70 patients with TB subsequently died. The incidence of TB in RA is about four times the national average (6.2/100,000 vs. 24.4/100,000). TB screening has become mandatory for patients prior to the start of infliximab therapy.

Infliximab therapy is contraindicated in congestive heart failure (CHF) based on a trial of patients with class III or IV CHF. The study was ended due to a worsening of CHF in the infliximab participants, leading to a warning now issued on the labeling of the drug.

Cancer has also been noted as a possible adverse effect due to immunosuppression. However, the incidence of malignancies seen in infliximab-treated patients does not differ from the predicted rates in the general population of the National Cancer Institute's Surveillance, Epidemiology, and End Results database (SEER).

Because infliximab is beneficial in several inflammatory disease states, further research may examine possible oral compounds that can provide the benefits of infliximab to help alleviate some of the administration issues (cost, infection, and compliance issues surrounding injected medications).