Monitoring Requirements for Patients on Infliximab

Tuberculosis Monitoring

Before starting infliximab, all patients should undergo tuberculosis screening including clinical history, physical examination, chest radiograph, and tuberculin skin testing (if not on immunosuppressive therapy) 2, 3, 4
Patients with abnormal chest radiographs or history of TB should be referred to a specialist with expertise in TB management 3, 5
Clinical awareness of TB should be maintained throughout anti-TNF treatment and for 6 months after cessation 6, 7
The majority of TB cases occur within three cycles of treatment (median 12 weeks), with extrapulmonary TB being common 7
For patients at high risk (e.g. certain ethnic groups), chemoprophylaxis should be considered before starting infliximab 8, 9
Close cooperation between prescribing clinicians and TB specialists is strongly recommended 3, 4

Platelet counts should be regularly monitored as thrombocytopenia occurs in a small percentage of patients 1
Less frequent biochemistry and hematology monitoring is required compared to conventional drug therapies, but regular clinical review remains essential 1

Patients should be seen at 12 weeks to determine whether therapy should be continued, then at 3-6 month intervals 1
For certain conditions, adequate response is defined as a significant reduction in symptoms and improvement in quality of life within 3 months 1
Therapy should be withdrawn if adequate response is not achieved after 3 months 1

Monitor for infusion reactions, which commonly include headache, fever, chills, and myalgia during the first few weeks of treatment 1
Watch for skin reactions, particularly a transient acute pruritic eruption between weeks 4-10 in flexural sites, arms, neck, and trunk 1

For patients on concomitant immunosuppressants, tuberculin skin tests may be unreliable (false negative); risk assessment should be individualized 2