infliximab

Overview

Infliximab is a therapeutic monoclonal antibody used in the treatment of immune-mediated inflammatory diseases. It is best known as an anti-TNFα biologic, meaning it binds tumor necrosis factor alpha and helps suppress downstream inflammatory signaling. Clinically, this mechanism has made infliximab an important therapy in conditions such as inflammatory bowel disease and other chronic inflammatory disorders in which TNF-driven immune activation contributes to tissue damage.

Because infliximab modulates a central inflammatory pathway, it is also a useful reference drug in translational research on biologic efficacy, safety, biosimilar switching, and mechanisms of treatment resistance. Recent studies have continued to use infliximab as a comparator, a treatment intervention, or a mechanistic benchmark alongside other biologics such as adalimumab, etanercept, ixekizumab, risankizumab, and ustekinumab.

Recent Publications Summary

Recent publications on infliximab have focused largely on inflammatory bowel disease, with efforts to refine precision dosing and understand comparative safety and real-world use. A pharmacokinetic modeling study evaluated 20 published infliximab population models across five inflammatory bowel disease datasets, including overall, acute severe ulcerative colitis, Crohn’s disease, fistulizing Crohn’s disease, and ulcerative colitis, using trough concentrations from routine therapeutic drug monitoring. The authors assessed predictive performance with median prediction error, median absolute prediction error, Bayesian forecast metrics, and simulation-based diagnostics to support phenotype- and severity-driven model selection for model-informed precision dosing 42497217Jul. In parallel, a retrospective population-based study from British Columbia examined the longer-term impact of mandatory non-medical switching policies on infliximab biosimilar utilization and continuation/discontinuation patterns in Crohn’s disease and ulcerative colitis 42157439May.

Several reports addressed infliximab’s clinical effectiveness and safety in specific inflammatory settings. In severe central nervous system tuberculosis, a retrospective cohort study evaluated low-dose infliximab (5 mg/kg) as adjunctive therapy in 20 patients and reported disability-free survival in 60% at 3 months, with 75% showing clinically meaningful improvement; these outcomes were described as comparable to prior high-dose infliximab reports 41856917Mar. A case report in Crohn’s disease described healing of a refractory ileocecal ulcer after infliximab following failure of adalimumab and risankizumab, with improvement associated with changes in mucosal claudin mRNA expression, suggesting a possible role for infliximab in restoring barrier integrity 41260649Nov. In pediatric inflammatory bowel disease, a narrative review noted that infliximab remains one of only a few advanced therapies approved for children and emphasized that anti-TNF benefit-risk data are more established than for many newer agents 42334183Jun.

Other publications placed infliximab in comparative or translational contexts. A retrospective cohort study using a national database compared the risk of heart failure in inflammatory bowel disease patients treated with infliximab versus adalimumab, reflecting ongoing concern about anti-TNF cardiac safety 42269048Jun. A study of a novel IGF-II-based masking domain for conditional activation of therapeutic antibodies reported that a protease-cleavable masked anti-TNFα antibody retained efficacy comparable to adalimumab and infliximab in a collagen antibody-induced arthritis model, while showing less measurable impact on survival in a Listeria monocytogenes challenge model than the reference antibodies 42093183May. In formulation research, dynamic light scattering-based hydrodynamic molecular weight modeling was applied to therapeutic proteins and found infliximab to have a hydrodynamic molecular weight several-fold greater than its monomeric molecular weight, consistent with oligomerization states reported in the literature 42373916Jun.

What Changes, What Holds

1. Precision dosing is becoming phenotype-specific, while switching policies may shape long-term persistence
METHOD The pharmacokinetic modeling work does not change infliximab’s established anti-TNF role, but it does move the drug’s use toward model-informed dosing that depends on disease phenotype and severity rather than a single universal exposure target 42497217Jul. The switching study adds a real-world utilization angle: mandatory non-medical biosimilar switching may affect continuation and discontinuation patterns over time, which matters for implementation but does not by itself overturn the baseline account of infliximab as a core IBD biologic 42157439May.

2. Infliximab remains a salvage option in difficult inflammatory disease, with pediatric use still anchored in the anti-TNF class
REINFORCES The central message is not a new role but a reminder that infliximab continues to be used when other advanced therapies fail, including in refractory Crohn’s disease, where the report is consistent with its established place in immune-mediated inflammation 41260649Nov. The tuberculosis cohort extends use into a severe infectious-inflammatory setting, but that is an additional application rather than a contradiction of the baseline; the pediatric review likewise reinforces that infliximab is among the better-established advanced therapies for children 41856917Mar42334183Jun.

3. Cardiac safety and molecular behavior remain active questions rather than settled properties
NEW DIRECTION The heart-failure comparison introduces a risk domain the Overview does not cover, so it adds a cautionary clinical context without displacing infliximab’s anti-TNF mechanism 42269048Jun. The formulation study similarly does not alter the baseline account of therapeutic use, but it suggests infliximab may exist in higher-order hydrodynamic states than its monomeric size implies, which is relevant to characterization and manufacturing rather than clinical efficacy 42373916Jun. Together these findings broaden how infliximab is monitored and studied.

Overview update candidates: precision dosing may need phenotype-specific model selection; real-world biosimilar switching can affect persistence; cardiac safety deserves continued attention; hydrodynamic oligomerization may be relevant to formulation characterization.