Remicade (infliximab): Uses and cautions
It is one of several tumor necrosis factor alpha (TNFα) inhibitors now available.
While effective against a range of autoimmune conditions, the drug's action can cause some severe infections to worsen, so caution is needed when using it.
Autoimmune diseases and TNFα
Remicade is administered intravenously.
Scientists and specialists still do not fully understand exactly why autoimmune diseases occur. They happen when the body's immune system mistakenly perceives healthy cells as bad, so it tries to destroy them.
TNFα delivers messages between cells in the body. Excess levels of TNFα can make the immune system attack healthy tissue and cause inflammation.
When the immune system is activated, TNFα appears to cause inflammation.
Studies suggest that TNFα plays a major role in the inflammation associated with most autoimmune diseases, including Crohn's disease, ankylosing spondylitis, and rheumatic arthritis.
These conditions all benefit from treatment with Remicade.
How does Remicade work?
Remicade belongs to a class of drugs known as biologics. These are therapies based on proteins that are usually antibodies.
The proteins have been developed through genetic engineering.
Remicade is a type of protein, a fully human monoclonal antibody. It is a TNF inhibitor, and it acts against a protein known as tumor necrosis factor alpha (TNFα).
It searches out, finds, and binds to TNFα, and it blocks its inflammatory effect.
This activity reduces inflammation and pain for patients with autoimmune diseases.
Remicade starts to take effect within 48 hours for some patients, while others may have to wait several weeks.
For best results, it is important to be patient and to adhere to the treatment regime.
However, because Remicade reduces immune system activity, it can also undermine the body's ability to infections. Patients who use Remicade must inform their doctor immediately if they think they might have an infection.
Remicade, or infliximab, is administered directly into a vein. This is called an intravenous infusion. It is done in a hospital or clinic.
It cannot be taken orally because the drug's active ingredient would be destroyed by the digestive system.
Uses of Remicade
Remicade can help people with rheumatoid arthritis who have not responded to other treatments.
Remicade can be prescribed to treat a number of conditions.
Moderate to severe rheumatoid arthritis (RA), or rheumatoid diseases: RA is a chronic, progressive autoimmune disease which causes inflammation and pain in the joints and the surrounding tissue, and sometimes other organs. RA can be severely disabling. Used with methotrexate, Remicade can help reduce signs and symptoms of RA.
Active ankylosing spondylitis: This is a long-term inflammation of the sacroiliac joints and the spine. The sacroiliac joints join the hips to the spine. There may be pain and stiffness in and around the spine area. The vertebrae may eventually fuse together in a process known as ankylosis. Some patients with Crohn's disease and psoriasis also have ankylosing spondylitis.
One clinical study has shown that patients with ankylosing spondylitis who took Remicade over 24 months had significant improvements in spinal mobility and sustained reductions in spinal inflammation.
Moderate to severe Crohn's disease: This is a long-term condition involving inflammation in the digestive tract. The inflammation can occur in any part of the gut, but it is more common in the lower part of the small intestine, or ileum. Pain and diarrhea are common features of Crohn's disease.
Moderate to severe ulcerative colitis: A relatively common, chronic disease that causes inflammation of the large intestine, or colon. Ulcerative colitis is a form of inflammatory bowel disease. In severe cases, painful ulcers may form, and these may bleed and produce pus and mucus.
Clinical studies indicate that Remicade can increase the quality of life for patients with ulcerative colitis.
Moderate to severe chronic plaque 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. Scale accumulates on the plaques and then flakes off. The skin can be itchy and painful, and it cracks easily.
A 2008 study has shown that patients experienced a rapid and substantial improvement in psoriasis in critical regions of body after using Remicade.
Cautions and adverse effects
A person should discuss their medical history with a doctor before taking remicade.
Remicade can lower the patient's ability to fight infections.
Older people who use Remicade can develop serious viral, bacterial or fungal infections that can then spread all over the body. These include tuberculosis (TB) and histoplasmosis.
Rarely, these can be fatal.
It is vital that patients are checked for signs of TB while using Remicade.
An increase in some types of cancer has been noted with Remicade use, and the United States Food and Drug Administration (FDA) carry a warning about this. Some people on TNF-blocker medications have developed unusual cancers.
Cases of a rare and fatal form of lymphoma, Hepatosplenic T-cell lymphoma, have been reported in a small number of mostly male patients under the age of 18 years with Crohn's disease or ulcerative colitis. The patients were using a combination of Remicade and azathioprine or 6-mercaptopurine.
Patients must inform their doctor if they have or have had TB, or if they have been in close contact with anyone who has TB.
They should also inform the doctor if they:
- Live or have lived in an area where there is a higher chance of histoplasmosis, coccidioidomycosis, or blastomycosis, including Ohio and the Mississippi River valleys
- Experience recurring infections
- Have an immune system problem
- Have diabetes
- Have or had cancer
- Have any cancer risk factor, such as COPD, or some types of psoriasis phototherapy
- Have or had any heart condition
- Have hepatitis B virus (HBV) infection, or if they may be a carrier
- Have a disorder of the nervous system, such as multiple sclerosis (MS)
The doctor needs to know about any current medications before deciding whether to prescribe Remicade, especially Kineret (anakinra), Orencia (abatacept) or Actemra (tocilizumab), which may be used to treat the same conditions as Remicade. As biologics are expensive, the physician will normally prescribe them for people who have not responded to other treatments.
Women need to tell the doctor if they are pregnant or plan to become pregnant, or are breastfeeding.
Patients should not be given a live vaccine while taking Remicade.
Women who took Remicade while pregnant need to tell the pediatrician and nurse before their child receives any pediatric vaccines.
Common side effects linked to Remicade include:
- Sinus infections
- Sore throat
- Stomach pain
Some more serious adverse effects must be reported immediately to a doctor.
- Any infection, fatigue, fever, flu, or alterations in the skin, and anything that may indicate there is an infection
- Any signs of cancer
- Liver problems, including jaundice
- Feeling tired, unwell, having a poor appetite, skin rash, or joint pain. These could indicate a reactivation of hepatitis B virus
- Any signs of a blood disorder, such as persistent fever, bleeding, pallor, or bruising
- Any signs of a nervous system disorder, including weakness, tingling, numbness, changes in vision, or seizures
- Any reactions during or following the infusion, such as breathing problems, chest pains, changes in blood pressure, swelling of the hands or face, chills, or fevers
- Lupus-like syndrome, a persistent pain or discomfort in the chest, joint pain, skin rash on the arms or cheeks that seem to get worse when exposed to sunlight
- Worsening or new symptoms of psoriasis
Signs of an allergic reaction include hives, difficulty breathing, chest pain, high or low blood pressure, fever, and chills.