Remicade for treatment of rheumatoid arthritis
Remicade is the brand name in Australia for a drug called infliximab. It has been found to be useful in treating the inflammation associated with some autoimmune conditions, such as Crohn’s disease and rheumatoid arthritis.
Autoimmune conditions are ones where the immune system of the body fails to distinguish between what is foreign and what is the body itself and so the immune system attacks and damages the body’s own tissues.
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 then may require surgery.
There are up to 60,000 Australians who suffer from rheumatoid arthritis. RA 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 (Remicade) work?
Infliximab is a monoclonal antibody which binds to human TNF-alpha and so ‘neutralises’ it and blocks its action. By blocking tumour necrosis factor-alpha in rheumatoid arthritis there is less 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 RA sufferers to have an increased quality of life.
Clinical trials of large numbers of patients have shown on X-rays that infliximab slows down the progression of rheumatoid arthritis.
Associate Professor Geoff McColl, Consultant Rheumatologist at Royal Melbourne Hospital, said: ‘With Remicade, we have a treatment that significantly reduces the joint damage caused by rheumatoid arthritis and returns sufferers to a more normal, daily routine. These are our main treatment goals in this insidious disease and at present, those with severe disease are most likely to benefit from this medication.’
Jacqui’s story
Severe sufferer, Jacqui Thomas, 27, who has lived with RA for the past 14 years, says this new treatment has made a dramatic improvement to her quality of life.
‘I’ve gone from literally having to crawl to the bathroom each morning and coping with constant, stabbing pain in my joints, to being pain-free and jumping out of bed each day full of energy with a new enthusiasm for life,’ she said.
How do you take it?
Infliximab can only be prescribed by a doctor or specialist. 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 by infusion via a drip into a vein which takes at least 2 hours.
Infliximab can suppress the immune system and so could put users at increased risk of opportunistic infection, for example reactivation of latent tuberculosis. For this reason, people with severe infections such as tuberculosis cannot take it. Infliximab is also not suitable for pregnant women and mothers who are breastfeeding and for people with congestive heart failure. It can sometimes bring on an allergic reaction, so people who are allergic to mouse proteins must not take it. The doctor or nurse will observe you for any allergic reaction before you go home after the infusion.
In October 2004, the US Food and Drug Administration published warnings that patients who use TNF-blocking medications, such as infliximab (Remicade), have a higher incidence of lymphoma than patients not receiving TNF blockers. In addition, patients on Remicade are advised to seek immediate medical attention if they develop persistent fever, bruising or bleeding.
Availability
Infliximab is indicated in Australia for use in selected patients with rheumatoid arthritis and also selected patients with Crohn’s disease. At present its availability on the Pharmaceutical Benefits Scheme is limited and its high cost may be prohibitive.
Last Reviewed: 09 November 2004
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