Remicade for treatment of Crohn's disease
Remicade is the brand name in Australia for a medicine called infliximab. It is useful in treating the inflammation associated with some autoimmune conditions, such as Crohn’s disease and rheumatoid arthritis.
Autoimmune conditions occur when the body’s immune system 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.
What is Crohn’s disease?
Crohn’s disease is an autoimmune disease in which a protein called tumour necrosis factor-alpha (TNF-alpha) is produced in larger than normal quantities. This results in inflammation of the bowel and damage to the bowel wall.
Crohn’s disease affects about 5 people in every 100,000 of the population. It is a life-long condition that can affect any part of the digestive tract.
How does infliximab work?
Infliximab is a monoclonal antibody made 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 and blocks TNF-alpha, which is involved in inflammation of the bowel. People with Crohn’s disease treated with infliximab should have a reduction in bowel inflammation, fewer signs and symptoms of the disease and improved healing of the bowel tissues.
Infliximab has also been shown to be effective in treating fistulae, which are a common complication of Crohn’s disease. Fistulae are abnormal channels that connect 2 nearby organs, e.g. the rectum and the vagina, causing further complications.
How effective is infliximab?
Infliximab has been tested in clinical trials of people with Crohn’s disease and found to be highly effective for treating those with active Crohn’s disease. Some people treated with infliximab have achieved remission of their disease.
How do you take it?
Infliximab can only be prescribed by a doctor. It is not suitable for all people with Crohn's disease. Your specialist should be able to advise if infliximab is suitable for you. It is given as a drip (an infusion) into a vein. The infusion takes at least 2 hours, and you will need to be observed after the infusion to check that you have no side effects.
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 such as tuberculosis cannot take this medicine. Infliximab is not suitable for pregnant women and mothers who are breastfeeding. It is also not suitable 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 take TNF-blocking medications such as infliximab have been shown to be 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 selected patients with Crohn’s disease. It is also available for the treatment of several other autoimmune conditions such as rheumatoid arthritis. It is expensive and its availability on the Pharmaceutical Benefits Scheme is restricted to specific conditions.
What if treatment doesn’t work?
Not everyone with Crohn’s disease responds to treatment with medicines and they many need to undergo surgery to remove affected parts of the bowel. This can result in a shortened bowel and/or a stoma, where faeces are expelled through a surgical hole in the skin and collected in a bag.
Last Reviewed: 05 February 2010
- 1. Colorectal Surgical Society of Australia & New Zealand. Crohn's disease [website]. 2006. http://www.cssa.org.au/content/4/26 (accessed Feb 2010).
2. von Roon AC, Reese GE, Orchard TR, Tekkis PP. Crohn's disease. Medical treatments to induce remission in adults. Infliximab to induce remission. BMJ Clinical Evidence; March 2007.
3. Schering Plough. Remicade powder for injection. Product Information. TGA approved Sep 2008 [revised Oct 2009].
