Bedfordshire and Luton Joint Prescribing Committee
Ref: JPC Bulletin 286
Bulletin Date: 01/12/19
Review Date: December 2022
Bulletin 286 Infliximab for the management of diarrhoea or colitis associated with Immune Checkpoint Inhibitor (ICPI) therapy
• The committee ratified the EoEPAC* bulletin including its list of recommendations below:. Full EoEPAC* bulletin is attached for information.
East of England Priorities Advisory Committee recommendations
o Infliximab is recommended for the treatment of severe Immune Checkpoint Inhibitor (ICPI) related diarrhoea or colitis grade 3 or 4, in line with the treatment pathway outlined in appendix 1.
o Treatment must be initiated and monitored under the guidance of a gastroenterologist and oncologist.
o Ipilimumab monotherapy and in combination with nivolumab must be permanently discontinued in patients with grade 3 or 4 diarrhoea or colitis.
o Other Immune Checkpoint Inhibitors (nivolumab monotherapy, pembrolizumab, atezolizumab) must be permanently discontinued in patients with grade four diarrhoea or colitis.
o All other causes, including cytomegalovirus (CMV) infection/reactivation and other viral, bacterial and parasitic aetiology, must be excluded along with any other clinical contraindications (e.g. gastrointestinal perforation or sepsis) before starting infliximab.
o A single dose of biosimilar infliximab 5mg/kg should be considered as a second line option for corticosteroid-refractory grade 3 or 4 diarrhoea or colitis related to the ICPI therapy, following treatment with systemic high-dose intravenous corticosteroids for three to five days.
o A second dose of infliximab at two weeks may be necessary for some patients. Very rarely a third dose may be required.
o Outcome data must be provided to the Clinical Commissioning Group (CCG) to inform future policy.
o These recommendations will be reviewed on publication of guidelines from the British Society of Gastroenterology or other national guidelines.