Infliximab
(Date: November 2022. Version: 4.2)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by the UK Health Security Agency (UKHSA) on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
Quick read
Infliximab can be used in pregnancy to treat inflammatory illnesses. Babies who were exposed in later pregnancy might be offered some of their vaccinations at a later time than usual.
What is it?
Infliximab (Remsima®, Flixabi®, Inflectra®, Remicade®, Zessly®) dampens the immune response. It is used to treat some autoimmune diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, Crohn’s disease, and ulcerative colitis.
What are the benefits of using infliximab in pregnancy?
Infliximab helps to stop the immune system from attacking the body. It controls the unpleasant and often disabling symptoms of some autoimmune diseases and helps to prevent ongoing damage to tissues and organs.
What are the risks of using infliximab in pregnancy?
The available data suggests that infliximab is unlikely to affect the baby’s development. There are reports of some babies being born with a low infant birth weight following infliximab exposure. However, it is unclear if this is caused by the drug itself or the underlying illnesses in pregnant women taking infliximab.
Infliximab used in later pregnancy can potentially affect the baby’s immune system for several months after birth. Live vaccines should be avoided during this time. This means that the baby cannot be vaccinated against rotavirus (as this needs to be completed by four months) and is unlikely to be offered the BCG vaccine (if required) until they are at least six months old. A doctor will be able to advise about the best time for the baby to be given any live vaccinations.
Are there any alternatives to using infliximab in pregnancy?
Possibly. Other immunosuppressant medicines can be used in pregnancy so switching to a different drug may be an option. Some women may also find that their illness improves by itself as pregnancy progresses and so a specialist may advise that treatment can be reduced.
Women on infliximab who are planning a pregnancy or who accidentally conceive should arrange to see their doctor or specialist as soon as possible. This is to check whether infliximab is still the best treatment and to make sure the dose is correct.
What if I prefer not to take medicines during pregnancy?
Pregnant women who have poorly controlled autoimmune disease may be at risk of adverse pregnancy outcomes, including miscarriage, preterm delivery, and low infant birth weight. To help reduce the chance of these outcomes and to stop an autoimmune disease from flaring, some women will be advised to continue taking infliximab in pregnancy. A doctor will only prescribe medicines when necessary and will be happy to talk through any concerns.
Will I or my baby need extra monitoring?
As part of routine antenatal care, most women will be offered a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. Women taking infliximab may be offered extra monitoring of the baby’s growth.
Are there any risks to my baby if the father has used infliximab?
There is currently no evidence that infliximab used by the father can harm the baby through effects on the sperm.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org
How can I help to improve drug safety information for pregnant women in the future?
Our online reporting system allows women with a current or previous pregnancy to create a digitally secure ‘my bumps record’. You will be asked to enter information about your health, whether or not you take any medicines, and your pregnancy outcome. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit https://www.medicinesinpregnancy.org/Login/ to register.
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General information
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.
www.medicinesinpregnancy.org