Perioperative Management of Infliximab

Introduction to Infliximab Management

The American College of Rheumatology recommends withholding infliximab prior to surgery and scheduling it at the end of the dosing cycle to minimize potential negative effects on bone healing and reduce infection risk, particularly for patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or juvenile idiopathic arthritis 1

For patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or juvenile idiopathic arthritis, infliximab should be withheld prior to surgery, with elective surgery scheduled at the end of the infliximab dosing cycle (week 9 for standard 8-week dosing) 1, 2
The American College of Rheumatology recommends planning surgery after the next dose is due for patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), and Juvenile Idiopathic Arthritis (JIA) 1, 3, 2
In cases where surgery cannot be delayed, proceed with surgery regardless of timing of last infliximab dose, as suggested by the European Crohn’s and Colitis Organisation 4

Individual patient factors, including severity of underlying disease, history of infections, complexity of planned surgery, and bone healing requirements of the procedure, should be considered when deciding whether to withhold infliximab 1
Patients with severe disease or difficult-to-control symptoms may consider continuing infliximab if pain relief from surgery outweighs potential infection risk and disease control would be significantly compromised by medication interruption, according to the American College of Rheumatology 1, 3

Infliximab can be resumed approximately 14 days after surgery, once the wound shows evidence of healing, sutures/staples are removed, and no significant swelling, erythema, or drainage is present, with no ongoing non-surgical site infection 1, 3
Recent evidence suggests better outcomes in patients who restart infliximab within 4 weeks after surgery compared to later resumption, according to the American College of Rheumatology 1, 3