What to know about infliximab (Remicade)
It is one of several TNF-alpha inhibitors now available.
Although it is effective against a range of autoimmune conditions, Remicade's effects on a person's immune system can cause some severe infections to get worse.
In this article, we look at the functions and side effects of Remicade, as well as how to take precautions against its more severe effects.
How does Remicade work?
People receive Remicade by intravenous infusion.
Remicade belongs to a class of drugs called biologics. These are medications that manufacturers derive from living proteins using genetic engineering.
Remicade uses a type of protein called a fully human monoclonal antibody. It acts against a protein called TNF-alpha and belongs to a group of medications called TNF inhibitors.
TNF inhibitors seek, find, and bind to TNF-alpha to block its inflammatory effects. This reduces inflammation and pain for people with some autoimmune conditions.
For some people, Remicade starts to take effect within 48 hours. Others may have to wait several weeks to feel relief from their symptoms.
For the best results, it is important to follow a doctor's advice about the treatment regimen and not to stop taking the medication.
However, as Remicade reduces immune system activity, it can also undermine the body's ability to protect itself against infections. For this reason, people who take Remicade must inform their doctor immediately if they think they have an infection.
Doctors administer Remicade directly into a vein through an intravenous infusion in a hospital or clinic.
Autoimmune conditions and TNF-alpha
Scientists still do not fully understand exactly why autoimmune conditions develop. They believe that it happens when the body's immune system mistakenly targets noninfectious cells and tries to destroy them.
TNF-alpha delivers messages between cells in the body. Having excess levels of TNF-alpha in the body can trigger attacks by the immune system on healthy tissue and cause inflammation.
TNF-alpha appears to cause inflammation during immune system activation.
One 2017 review suggested that TNF-alpha plays a major role in the inflammation associated with most autoimmune conditions, including Crohn's disease, ankylosing spondylitis, and RA.
People with these conditions tend to benefit from treatment with Remicade.
Remicade can help relieve symptoms for people with a number of conditions. In the following sections, we discuss these conditions:
RA is a chronic, progressive autoimmune condition that causes inflammation and pain in the joints and surrounding tissue. RA sometimes affects other organs.
RA can be debilitating and painful. However, when a person with RA takes Remicade alongside methotrexate, it can help reduce symptoms and improve their quality of life.
Active ankylosing spondylitis
This is a long term inflammation of the sacroiliac joints and the spine.
The sacroiliac joints connect the hips to the spine. Ankylosing spondylitis may cause pain and stiffness in and around the spine.
The vertebrae may eventually fuse together in a process called ankylosis. Some people with Crohn's disease and psoriasis also develop ankylosing spondylitis.
Moderate-to-severe Crohn's disease
This is a long term condition that triggers inflammation in the digestive tract.
The inflammation can occur in any part of the gut, but it is more likely to affect the lower part of the small intestine, or the ileum. Pain and diarrhea are common features of Crohn's disease.
Moderate-to-severe ulcerative colitis
This is a relatively common chronic condition that inflames the large intestine, or the colon.
Ulcerative colitis is a form of inflammatory bowel disease. In people with severe ulcerative colitis, painful ulcers may form. These may bleed and produce pus and mucus.
Although Remicade is effective for many people with ulcerative colitis, it may eventually lose its effectiveness in those whose ulcers are severe enough to produce mucus.
Moderate-to-severe chronic plaque psoriasis
People use Remicade to treat moderate-to-severe psoriasis.
This is the most common type of psoriasis.
Symptoms include very dry skin and well-defined patches of red raised skin, or plaques, particularly around the knees, elbows, scalp, trunk, and nails.
Scales build up on the plaques and then flake off. The skin can be itchy and painful, and it can crack easily.
Remicade can reduce the ability of a person's body to fight infections.
Older adults who use Remicade can develop serious viral, bacterial, or fungal infections, including tuberculosis (TB) and histoplasmosis, that can then spread all over the body.
In rare circumstances, these infections can be fatal. For this reason, is vital that doctors check people who are taking Remicade for signs of TB.
There also seems to have been an increase in some types of cancer after taking Remicade. Specifically, some people taking TNF inhibitors have developed unusual cancers. The Food and Drug Administration (FDA) carry a warning about this possible effect.
The FDA explain that doctors have reported the occurrence of a rare and fatal form of lymphoma, called hepatosplenic T-cell lymphoma, in a small number of mostly male patients under the age of 18 years who have Crohn's disease or ulcerative colitis.
They were using a combination of Remicade and azathioprine or 6-mercaptopurine.
People who are to start taking Remicade must inform their doctor if they have or have ever had TB, or if they have had close contact with anyone who has TB.
They should also inform the doctor if they:
- live or have lived in an area with a higher chance of histoplasmosis, coccidioidomycosis, or blastomycosis, including Ohio and the Mississippi River valleys
- experience recurring infections
- have immune deficiency
- have diabetes
- have or have had cancer
- have any cancer risk factor, such as chronic obstructive pulmonary disease
- have undergone some types of phototherapy treatment
- have or have had any heart condition
- have or have had a risk of carrying hepatitis B virus (HBV)
- have a condition of the nervous system, such as multiple sclerosis
Before the doctor can decide whether or not to prescribe Remicade, a person should tell their doctor about any current medications they are taking. This is especially important if the person is already taking anakinra (Kineret), abatacept (Orencia), or tocilizumab (Actemra).
Doctors may prescribe these drugs to treat the same conditions they would prescribe Remicade for. As biologics have a strong cost consideration associated with them, the physician will normally only recommend them to people for whom other treatments have not been successful.
Women need to inform their doctor if they are pregnant, plan to become pregnant, or are breastfeeding.
Also, people should not receive a live vaccine while taking Remicade.
Coughing may be an adverse effect of Remicade.
Any women who took Remicade while they were pregnant need to tell the pediatrician and nurse before their child receives any vaccines.
Common side effects of Remicade include:
- sinus infections
- sore throat
- stomach pain
People should report more serious adverse effects to a doctor immediately. These include:
- alterations in the skin
- any signs of cancer
- liver problems, including jaundice
- bleeding, pallor, or bruising, which could suggest a blood disorder
- a poor appetite, skin rash, or joint pain, which may indicate a reactivation of HBV
- any weakness, tingling, numbness, changes in vision, or seizures that point to a nervous system disorder
- any reactions during or directly after the infusion, such as breathing problems, chest pains, changes in blood pressure, swelling of the hands or face, chills, or fever
- any lupus-like symptoms, such as persistent pain or discomfort in the chest, joint pain, or a rash on the arms or cheeks that seems to get worse when exposed to sunlight
- worsening or new symptoms of psoriasis
A doctor should not prescribe a dosage higher than 5 milligrams per kilogram to people with heart failure unless the physician specifically allows it. Also, people who have previously had an allergic reaction to Remicade should not take it again.
Signs of an allergic reaction to Remicade include:
- difficulty breathing
- chest pain
- high or low blood pressure
If any of these occur, a doctor may be able to recommend alternatives.
As long as people taking Remicade follow their instructions closely and regularly check in with a doctor about their treatment regimen, the medication can provide effective relief for people with chronic autoimmune and inflammatory conditions.
How much does Remicade cost, and will my insurer pay for it?
According to the GoodRx Remicade price survey at https://www.goodrx.com/remicade, the price of Remicade without insurance and including a manufacturer coupon ranges from about $5,754 to $6,103 for five vials of Remicade 100 milligrams.
If a person has insurance, their out-of-pocket cost will vary but could be as little as $5.00 per infusion with a coupon.
Many insurance plans require a prior authorization before covering, so people should be sure to call their insurance company to get details on what steps they and their doctor may need to take to get coverage authorized for Remicade.Alan Carter, PharmD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.