The Facts of Remicade

Remicade (infliximab) is a biologic response modifier, specifically a monoclonal antibody which binds to and blocks tumor necrosis factor alpha (TNF-alpha). Tumor necrosis factor (TNF) alpha is a cytokine involved in the inflammatory process.

Excess TNF-alpha has been blamed for inflammation and joint damage characteristic of rheumatoid arthritis and other forms of inflammatory arthritis.

Remicade was the second TNF inhibitor to be approved by the U.S. Food and Drug Administration in 1999.

Enbrel was the first anti-TNF drug and was approved in 1998.

Humira was approved in 2002.

• Remicade uses human and mouse proteins to create a chimeric monoclonal antibody.
• Enbrel is derived by introducing human DNA into Chinese hamster ovary cells and creating a genetically engineered protein.
• Humira uses fully human proteins and phage display technology to produce monoclonal antibodies.

Remicade is administered as an intravenous infusion (I.V.). Usually a nurse administers the I.V. which takes about 2 hours to infuse. Remicade must be ordered by your doctor and requires insurance pre-authorization.

Remicade is approved alone or in combination with methotrexate to treat moderate to severe rheumatoid arthritis. Remicade is also approved for the treatment of active psoriatic arthritis.

Other conditions which have benefited from Remicade infusions include:

Juvenile rheumatoid arthritis

Ankylosing spondylitis

Uveitis

Psoriasis

Sarcoidosis

Crohn's disease

For the treatment of rheumatoid arthritis, the recommended dose of Remicade is 3 mg/kg. The initial dose of Remicade is followed by subsequent doses at two and six weeks. A maintenance dose of 3 mg/kg is infused every 8 weeks. Some patients who do not respond well with this regimen may shorten the interval between Remicade infusions or increase the dose. It is recommended that methotrexate be taken in combination with Remicade. The combination is effective, while minimizing side effects.

Remicade is contraindicated in pregnant or nursing women. Remicade should not be given to people with a history of serious infection or people with uncontrolled diabetes. Remicade should not be given to patients with with moderate to severe congestive heart faiure. Also, a tuberculin skin test must precede treatment with Remicade.

Some patients can develop autoantibodies following treatment with Remicade. The autoantibodies can develop into a lupus-like condition, but it is rare.

Common side effects associated with Remicade include:

upper respiratory infections

urinary tract infections

headache

nausea

cough

diarrhea

weakness

fever

back pain

skin conditions

infusion site reactions

Patients on Remicade may have a higher risk of developing cancer or lymphoma. People with rheumatoid arthritis have a higher risk of lymphoma, making it hard to determine which is directly responsible.

People on Remicade may develop a demyelinating disorder (multiple sclerosis), but this is rare.

Remicade should not be used by congestive heart failure patients.

Remicade can cause an infusion reaction in some patients (itching, chills, flushing, low blood pressure etc.)

If Remicade is discontinued and later re-started, there is a chance of allergic reaction. Some of the allergic reactions were serious which followed re-treatment with Remicade.

More About Remicade

TNF Blockers (Enbrel, Remicade, Humira) - Test Your Knowledge

Allergic Reaction To Remicade

Biologic Response Modifier - What Is It?

Unsuitable Candidates For Biologics

Switching TNF Blockers

_{Sources: Arthritis Without Pain, Scott J. Zashin, M.D., 2004; Arthritis - A Cleveland Clinic Guide, John D. Clough, M.D., 2006; Infliximab, MedicineNet.com; The Pill Book, 10th Edition; Remicade - Patient Information Leaflet}