Remicade for treatment of rheumatoid arthritis
Remicade is the brand name in Australia for a medicine called infliximab. It is used to treat the inflammation associated with some autoimmune conditions, such as Crohn’s disease and rheumatoid arthritis.
Autoimmune conditions occur when the immune system of the body fails to distinguish between what is foreign (e.g. a virus or bacterium) and what is the body itself, and so the immune system attacks and damages the body’s own tissues.
What is rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease in which there is too much of a protein called tumour necrosis factor-alpha (TNF-alpha) in the joints. This leads to inflammation and damage of the joints.
Rheumatoid arthritis is a painful, progressive disease and without effective treatment the inflammation and damage to joints can lead to destruction of a joint which eventually may require surgery.
Up to 400,000 Australians suffer from rheumatoid arthritis. Rheumatoid arthritis is particularly common among women and usually affects people aged between 25 and 50. Symptoms can include joint pain (usually symmetrical — in both wrists, for example), a feeling of ill-health, morning stiffness in joints and swelling of joints.
How does infliximab work?
Infliximab is a monoclonal antibody produced from human and mouse proteins. Monoclonal antibodies are produced in the laboratory to recognise and bind to specific proteins in the body. Infliximab binds to human TNF-alpha and so ‘neutralises’ it and blocks its action. By blocking TNF in people with rheumatoid arthritis, infliximab reduces the inflammation in the joints.
How effective is infliximab?
Infliximab reduces signs and symptoms of rheumatoid arthritis and prevents joint damage. It has also been shown to improve the physical function of joints, thus enabling people with rheumatoid arthritis to have an increased quality of life.
Clinical trials of large numbers of patients have shown that infliximab slows down the progression of rheumatoid arthritis.
How do you take it?
Infliximab can only be prescribed by a doctor. It is not suitable for all patients with rheumatoid arthritis. Your specialist should be able to advise whether infliximab is suitable for you. It is given as a drip (an infusion) into a vein. The infusion will last at least 2 hours and you will need to be observed after the infusion to check that you have no side effects.
If you are treated with infliximab for rheumatoid arthritis, you will also be given another medicine called methotrexate as part of your treatment.
Side effects
Infliximab can suppress the immune system and so could put people taking it at increased risk of opportunistic infection, for example reactivation of latent tuberculosis. For this reason, people with severe infections cannot take this medicine. Infliximab is also not suitable for pregnant women and mothers who are breastfeeding, nor for people with congestive heart failure.
Infliximab can sometimes bring on an allergic reaction, so people who are allergic to murine (mouse) proteins must not take it. The doctor or nurse will observe you for any allergic reaction before you go home after the infusion.
People who are being treated with TNF-blocking medications such as infliximab are at a higher risk of developing lymphoma than people not receiving TNF blockers. Your doctor can discuss this potential risk with you before treatment.
People taking infliximab are advised to seek immediate medical attention if they develop persistent fever, bruising or bleeding.
Availability
Infliximab is available in Australia on the Pharmaceutical Benefits Scheme for the treatment of selected adults with rheumatoid arthritis. It is also available for the treatment of some other autoimmune conditions such as Crohn’s disease. It is expensive and its availability on the Pharmaceutical Benefits Scheme is limited to specific conditions.
Last Reviewed: 05 February 2010
- 1. Australian Institute of Health and Welfare. A picture of rheumatoid arthritis in Australia.
Arthritis series no. 9. Cat. no. PHE 110. Canberra: AIHW; 2009. Available from: http://www.aihw.gov.au/publications/phe/phe-110-10524/phe-110-10524.pdf (accessed Feb 2010).
2. Schering Plough. Remicade powder for injection. Product Information. TGA approved Sep 2008 [revised Oct 2009].
