| Infliximab | Cyclosporine | Tacrolimus |
Tests before treatment | Excluding tuberculosis; serology for varicella, hepatitis B, and hepatitis C (and HIV when appropriate). | Serum creatinine, glucose, electrolytes (including magnesium), serum cholesterol. | |
Initial dosing | 5 to 10 mg/kg for dose 1. Emerging data in ASC indicate that intensified induction is more successful than standard 5 mg/kg given at weeks 0, 2, and 6. | 2 mg/kg/day continuous intravenous infusion. | 0.1 mg/kg per dose orally twice daily. |
Main toxicity | Infusion reactions, immune suppression, and rare opportunistic infections. | Hypertension, hyperglycemia, hypomagnesemia, immune suppression, azotemia, seizures (dose- and hypercholesterolemia-dependent), hirsutism, gingival hyperplasia. | As per cyclosporine, but less hirsutism and gingival hyperplasia. Additionally, self-remitting tremor. |
Ongoing treatment following response | Continue regularly scheduled maintenance infusions (4 to 8 weeks), ideally guided by therapeutic drug monitoring. | Initiate thiopurines (or other agent to maintain remission such as vedolizumab) so that cyclosporine can be discontinued within several months. | As per cyclosporine. |
Target drug levels during induction | Limited data on target levels during induction. | Aim initially for 150 to 300 ng/mL. | Aim initially for 10 to 15 ng/mL. |
Target levels once response achieved | 5 to 10 microgram/mL at trough during maintenance. | 100 to 200 ng/mL once remission achieved. | 5 to 7 ng/mL once remission achieved; longer duration treatment using lower levels of 2 to 5 have been reported. |
Monitoring/prevention of toxicity | PJP prophylaxis to be considered with IMM and steroids. | PJP prophylaxis to be strongly considered with IMM and steroids. Monitor drug levels, creatinine, glucose, electrolytes (including magnesium), lipid levels, blood pressure. | PJP prophylaxis to be strongly considered with IMM and steroids. Monitor drug levels, creatinine, glucose, electrolytes (including magnesium), lipid levels, blood pressure. |