Treating inflammatory bowel disease

Transcription

1 Treating inflammatory bowel disease Anti TNFa (Infliximab, Adalimumab and Golimumab) Information for patients Gastroenterology

2 This leaflet should not replace the information provided by the drug manufacturer. Please ensure that you read the manufacturer's information leaflet as well. What are Infliximab, Adalimumab and Golimumab and what do they do? Infliximab and adalimumab (Humira) are used to treat severe Crohn s disease and ulcerative colitis. Golimumab (Simponi) is used to treat ulcerative colitis These drugs target a protein called tumour necrosis factor alpha (TNFa). This is produced as part of the body s immune system. It is part of the inflammatory response which fights infections. In inflammatory bowel disease (IBD) there is an overproduction of TNFa which causes ongoing inflammation. Infliximab, adalimumab and golimumab reduce inflammation by blocking the action of TNFa. How and when should I take the medication? Initially all three treatments are given on the day case ward. Infliximab is given as an intravenous infusion (through a drip) which takes 2 hours. Initial treatments are given at weeks 0, 2 and 6. In patients who respond to treatment, maintenance infusions are then given every 8 weeks. Adalimumab and golimumab are given as sub-cutaneous (under the skin) injections. These treatments are available in either a pre-filled syringe or an injection pen. Patients attend hospital for the first 2 treatments which are given two weeks apart. You would be taught how to administer the injections so that you can continue the treatment at home. page 2 of 8

3 In those patients who respond to treatment, maintenance adalimumab is taken every two weeks and golimumab is taken every 4 weeks. How long will the drug take to work? The drug can take a few weeks to take effect, but some patients may see an improvement in their symptoms within a few days. How long will I need to take the treatment for? Patients on maintenance treatment are reassessed after 12 months. This is often done by colonoscopy or capsule endoscopy (pill cam). Treatment may be stopped if you have responded to the drug and no active disease is found. Are there any side effects or risks? The common side effects of infliximab, adalimumab and golimumab include: Headache Abdominal pain Nausea Infections of the chest / throat / urinary tract Dry skin / rash Increased sweating Joint pains There is a risk of having an allergic reaction to infliximab, although this is rare. Symptoms include shortness of breath, flushing and raised pulse or blood pressure. If this happens, the treatment may have to be stopped. To help reduce the chance of having a reaction to infliximab we give a steroid (Hydrocortisone) intravenously before each infusion. page 3 of 8

4 Some people have developed serious infections during treatment with infliximab, adalimumab and golimumab. If you develop any symptoms of infection, such as raised temperature or flu-like symptoms, you should contact your GP for advice as soon as possible. If you develop an infection your infliximab, adalimumab or golimumab treatment should be stopped immediately. You should not re-start treatment until the infection has been treated. It is important that you talk to your doctor or IBD nurse before re-starting treatment. The risk of developing some types of cancers, notably skin cancer and lymphoma, is increased in patients whose immune system is suppressed over a long period of time. What will happen if I don t take this medication? Talk to your doctor or IBD nurse about what other treatment options are available, these might include drug treatments or surgery. Will I need any tests? Before starting these treatments, you will need to have blood tests and a chest X-ray to exclude a number of infections. If you have a fistula, you would normally have an MRI scan to detect any abscesses or collections, as these will need to be treated before you can start treatment. After your treatment, you will need to have blood tests including liver function tests, full blood count, and inflammatory markers to monitor your response to the treatment. page 4 of 8

5 Is there anything I should avoid or take alongside this medication? It is important that you do not have any live vaccines while taking these drugs. Your GP or practice nurse should be able to advise you about suitable vaccines. Because these drugs affect your immune system we would advise that you attend your GP practice for a seasonal flu jab, pneumococcal vaccination and that women attend for their routine cervical screening tests. What if my partner and I want to start a family? In general the benefits of taking these medications outweigh the risks to both mother and baby, particularly when the IBD has been active or severe. However these drugs should be used with caution in pregnancy. Women are advised to talk to their doctor if they are planning a pregnancy. Infliximab, adalimumab and golimumab are normally stopped in the third trimester of pregnancy. This is because the drug crosses the placenta, which could affect the baby s immune system. If you are treated with these drugs during pregnancy your baby should not receive any live vaccines for at least 6 months after your last treatment. Please discuss this with your GP or health visitor. Women taking these drugs should discuss breast feeding with their specialist. Small amounts of the drug or its break down products may pass into the breast milk. page 5 of 8

6 Do I need to tell you about other medication I am taking? Please tell your doctor or nurse about all the medication that you are taking, including over-the-counter medicines. What should I do if I take more medication than I should? Do not take any further doses and contact your doctor or nurse specialist straight away. What should I do if I forget to take my medication? If you forget to take your adalimumab, re-start as soon as you remember and take the next injection 2 weeks later. If you forget to take your golimumab, re-start as soon as you remember and take your next injection 4 weeks later. Do not double up to make up for a missed injection. How do I store this medicine? Adalimumab and golimumab injections should be stored in a sealed container and kept refrigerated. How do I get a repeat prescription? If you collect your injections from the hospital you will need to contact the IBD nurses when you require a repeat prescription. We can arrange for the treatment to be delivered to your home. You will be given an information pack and contact details for the delivery company. Who do I contact if things get worse? Contact your IBD nurse or GP. page 6 of 8

7 Where can I find more information? If you would like any more information about these treatments, please talk to your doctor, IBD nurse specialist or pharmacist. Who can I contact if I have any questions? The inflammatory bowel disease (IBD) nurse specialists can be contacted as follows: Kerry Robinson & Alison Wright Royal Hallamshire Hospital Bev Fieldsend & Joanna Armitage Northern General Hospital Further information is also available from the following website: page 7 of 8

8 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD4248-PIL692 v5 Issue Date: May Review Date: May 2021