Infliximab is a biological medicine (monoclonal antibody) that reduces inflammation by blocking Tumour Necrosis Factor-alpha (TNF α).

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It may be prescribed for:

☐ Crohn's Disease

☐ Ulcerative Colitis

☐ Rheumatoid Arthritis

☐ Ankylosing Spondylitis

☐ Psoriatic Arthritis

☐ Plaque Psoriasis

☐ Behçet's Disease

☐ Sarcoidosis

☐ Other inflammatory condition

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EXPECTED BENEFITS

Treatment may:

☐ Reduce inflammation

☐ Reduce symptoms

☐ Improve quality of life

☐ Promote disease remission

☐ Reduce steroid requirements

☐ Reduce hospital admissions

☐ Prevent disease progression

☐ Promote healing of inflammatory disease

I understand individual responses vary and treatment cannot be guaranteed to be effective.

 

ALTERNATIVE TREATMENTS

Reasonable alternatives discussed include:

☐ Other biologic medicines

☐ Small molecule therapies

☐ Corticosteroids

☐ Immunomodulators

☐ Surgery (where appropriate)

☐ Observation

☐ No treatment

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BEFORE STARTING TREATMENT

I understand I may require assessment before treatment begins.

This may include:

☐ Tuberculosis (TB) screening

☐ Hepatitis B screening

☐ Hepatitis C screening

☐ HIV screening (where appropriate)

☐ Chest X-ray (where indicated)

☐ Blood tests

☐ Pregnancy assessment (where appropriate)

☐ Vaccination review

 

I HAVE INFORMED MY CLINICIAN IF I HAVE

Current infection 

Fever 

Tuberculosis

Hepatitis

HIV 

Cancer

Heart failure

Multiple sclerosis

Pregnancy 

Breastfeeding 

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COMMON SIDE EFFECTS

Common side effects include:

☐ Headache

☐ Nausea

☐ Fatigue

☐ Flushing

☐ Mild rash

☐ Itching

☐ Fever

☐ Chills

☐ Mild infusion reactions

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MATERIAL RISKS

I understand Infliximab may increase my risk of:

☐ Serious infection

☐ Opportunistic infection

☐ Tuberculosis reactivation

☐ Hepatitis B reactivation

☐ Pneumonia

☐ Sepsis

☐ Delayed wound healing

☐ Blood abnormalities

☐ Liver inflammation

☐ Lupus-like syndrome

☐ Psoriasis-like skin reactions

☐ Demyelinating disorders

☐ Heart failure worsening

☐ Malignancy (rare)

☐ Lymphoma (rare)

☐ Severe allergic reaction

☐ Anaphylaxis

☐ Delayed hypersensitivity

☐ Serum sickness-like reactions

☐ Requirement for hospital admission

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INFUSION REACTIONS

Infusion reactions may occur during or shortly after treatment.

Symptoms may include:

☐ Itching

☐ Rash

☐ Chest tightness

☐ Wheezing

☐ Difficulty breathing

☐ Facial swelling

☐ Fever

☐ Chills

☐ Back pain

☐ Hypotension

☐ Hypertension

☐ Collapse

If these occur, treatment may be stopped and emergency medications administered.

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VACCINATIONS

I understand:

☐ Live vaccines are generally not recommended during treatment.

☐ I should discuss vaccinations with my treating clinician.

☐ I should inform healthcare providers I receive Infliximab.

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WHEN SHOULD I SEEK URGENT MEDICAL REVIEW?

Following treatment I should seek urgent medical attention if I develop:

☐ Fever

☐ Persistent cough

☐ Shortness of breath

☐ Chest pain

☐ Severe rash

☐ Facial swelling

☐ Severe abdominal pain

☐ Persistent diarrhoea

☐ Jaundice

☐ Unexplained bruising

☐ Severe headache

☐ Neurological symptoms

☐ Any signs of infection

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BIOSIMILAR ACKNOWLEDGEMENT

I understand:

☐ My treating clinician may prescribe an approved biosimilar rather than the original brand.

☐ Approved biosimilars have been evaluated by the Therapeutic Goods Administration (TGA) for quality, safety and efficacy.

☐ I have had the opportunity to discuss any questions regarding biosimilar medicines.

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PATIENT ACKNOWLEDGEMENT

I acknowledge that:

☐ My diagnosis has been explained.

☐ The reason Infliximab has been recommended has been explained.

☐ Expected benefits have been discussed.

☐ Reasonable alternatives have been discussed.

☐ I understand the common side effects.

☐ I understand the material risks relevant to my circumstances.

☐ I understand my increased risk of infection.

☐ I understand the importance of reporting signs of infection promptly.

☐ I understand that tuberculosis and hepatitis screening are recommended before treatment.

☐ I understand emergency treatment may become necessary during my infusion.

☐ I understand no treatment outcome can be guaranteed.

☐ I have had sufficient opportunity to ask questions.

☐ My questions have been answered.

☐ I understand I may withdraw my consent before treatment commences.

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