Name of the Procedure:

Injection, infliximab, excludes biosimilar, 10 mg (HCPCS Code J1745)

Summary

Infliximab is a medication administered through an injection to treat inflammatory conditions by targeting a specific protein in the body's immune system. This procedure involves giving the patient infliximab through an intravenous (IV) infusion.

Purpose

Infliximab is used to treat autoimmune diseases such as Crohn's disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriasis, and psoriatic arthritis. The goal is to reduce inflammation, alleviate symptoms, and improve the patient's quality of life.

Indications

• Moderate to severe Crohn's disease or ulcerative colitis
• Rheumatoid arthritis that hasn't responded to other treatments
• Ankylosing spondylitis causing significant symptoms
• Moderate to severe plaque psoriasis
• Psoriatic arthritis not effectively managed by other medications

Preparation

• Patients may need to undergo some blood tests or screenings to ensure they don't have infections like tuberculosis.
• Review and adjust current medications under a doctor’s guidance.
• Patients should inform their healthcare provider of any history of infections or allergic reactions.

Procedure Description

1. The patient is seated comfortably, usually in a reclining chair.
2. An IV line is inserted into a vein, typically in the arm.
3. Infliximab, a biologic medication, is administered intravenously over a period of about 2 hours.
4. The healthcare team monitors the patient for any adverse reactions during and immediately following the infusion.

Duration

The infusion typically takes about 2 hours, but the entire visit may take longer to include preparatory and observational time.

Setting

This procedure is usually performed in an outpatient clinic, hospital, or specialized infusion center.

Personnel

• Registered Nurse (RN) administers the infusion and monitors the patient.
• A physician oversees the treatment plan and manages any complications.
• Pharmacist may be involved in preparing the medication.

Risks and Complications

• Common: Headache, nausea, sinusitis, upper respiratory infections, and abdominal pain.
• Rare: Serious infections, heart failure, liver damage, and infusion reactions such as rash, fever, or chills.
• Management: Immediate medical attention and discontinuation of infusion if severe reactions occur.

Benefits

• Reduction in inflammation and relief from symptoms.
• Improved joint function and decreased pain in arthritis cases.
• Potential to induce remission in inflammatory bowel disease.

Recovery

• Most patients can resume normal activities immediately, although some may experience fatigue.
• Follow-up appointments are crucial to monitor the effectiveness and tolerance of the treatment.
• It's important to adhere to scheduled maintenance infusions every 6-8 weeks.

Alternatives

• Other biologic therapies that target different pathways.
• Non-biologic disease-modifying antirheumatic drugs (DMARDs).
• Corticosteroids and immunosuppressive agents. Pros and cons of alternatives vary, with some having different side effect profiles or levels of efficacy.

Patient Experience

• Patients might feel minor discomfort from the IV insertion.
• During the infusion, patients can often relax, read, or use electronic devices.
• Some patients may feel tired or have mild side effects post-infusion, but most experience a noticeable reduction in symptoms over time. Pain management and patient comfort measures include using numbing cream for IV insertion and providing blankets during the infusion.