Remicade for treatment of Crohn's disease
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.
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, resulting in inflammation of the bowel and damage to the bowel wall.
How does infliximab work in Crohn’s disease?
TNF-alpha is involved in inflammation of the bowel, so when TNF-alpha is blocked by infliximab, Crohn’s disease sufferers often see a reduction in bowel inflammation, with fewer signs and symptoms, 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. They can lead to faeces weeping onto the skin or into the vagina and hence infection and often the collection of pus.
How effective is it?
Infliximab has been tested in clinical trials of people with Crohn’s disease and found to be highly effective for treating active Crohn’s disease. A review of several clinical trials found one-third of patients treated with infliximab achieved remission of their disease.
How do you take it?
Infliximab can only be prescribed by a doctor or specialist. It is not suitable for all patients with Crohn's disease. Your specialist should be able to advise if infliximab is suitable for you. It is given by infusion via a drip into a vein which takes at least 2 hours.
Availability
Infliximab is indicated in Australia for selected patients with Crohn’s disease. Unfortunately, at present it is not available for Crohn's disease on the Pharmaceutical Benefits Scheme, and the high cost of a private prescription may be prohibitive.
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 not suitable for pregnant women and mothers who are breastfeeding. It is also not suitable 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.
Who might benefit from infliximab?
More than 10,000 Australians suffer from Crohn’s disease, which is a life-long condition that can affect any part of the digestive tract. Not everyone responds to medication and so many sufferers undergo surgery to remove affected parts of the bowel. This can result in a short bowel and/or a stoma, which is an abdominal bag to collect faeces.
Angela McAvoy, Managing Director of the Australian Crohn’s and Colitis Association, said Remicade (infliximab) offers people with Crohn’s disease an opportunity to live a normal life.
Last Reviewed: 09 November 2004
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