Infliximab for rheumatoid arthritis

Examples

Generic Name	Brand Name
infliximab	Remicade

Infliximab is given by injection (infusion) into a vein (intravenously) every 4 to 8 weeks.

How It Works

Infliximab reduces the effects of tumour necrosis factor (TNF). TNF is a protein that attaches to the joint surface and causes inflammation and joint damage. Infliximab blocks the action of TNF and helps reduce the symptoms and slow the progression of rheumatoid arthritis. Infliximab is an immunosuppressive medication, which means that it reduces the activity in the body's immune system. Infliximab is a disease-modifying antirheumatic drug (DMARD), which means it slows the progression of rheumatoid arthritis. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).

Infliximab is usually combined with methotrexate to slow the progression of joint damage in people with moderate or severe rheumatoid arthritis.¹

Why It Is Used

Infliximab has shown good results in slowing the progression of rheumatoid arthritis and, in doing so, providing relief from pain and inflammation.¹

It also can be used to treat inflammatory bowel disease (ulcerative colitis or Crohn's disease) and psoriatic arthritis.

How Well It Works

Studies have shown that people with rheumatoid arthritis experience a rapid improvement in their symptoms when infliximab and methotrexate are used together. Infliximab reduces disease activity within weeks rather than several months, as with most other DMARDs.¹

Side Effects

Because infliximab is a protein that is injected (infused) into the vein, your body may have a reaction to the infusion. You will be given acetaminophen and diphenhydramine before infusions to prevent chills and light-headedness. But, some people cannot adjust to the infusion and cannot tolerate the treatment. Although an infusion can be uncomfortable, frightening, and potentially serious, the effects can be treated and reversed rapidly.

During the infusion, you may have an infusion reaction, including:

• Body aches, chills, light-headedness, nausea, and/or shortness of breath.
• Chills.
• Light-headedness.
• Nausea.
• Shortness of breath.

Warnings about serious side effects of infliximab (Remicade) have been issued. Health Canada's Therapeutic Products Directorate (TPD), the U.S. Food and Drug Administration (FDA), and the drug’s manufacturer have stated that people taking infliximab may have a greater chance of blood or nervous system disorders. Some of these problems are potentially fatal. These side effects are rare, and they may not be caused by infliximab. But contact your health professional if you develop symptoms of blood disorders (such as bruising or bleeding) or nervous system problems (such as numbness, weakness, tingling, and vision problems).

After the infusion, common side effects from infliximab include:

• Upper respiratory infections.
• Fatigue.
• Body aches following an infusion.

Risk of infection

Infliximab decreases the activity of your body's immune system, which increases the risk of a serious bacterial infection. Some people who take infliximab develop an infection that requires oral antibiotics; a smaller number of people will develop an infection that requires intravenous antibiotics and hospitalization. Contact your health professional if you develop any of the following symptoms:

• Fever or chills
• Increased frequency of or burning during urination
• A cough with yellow sputum or shortness of breath
• A skin infection
• Severe abdominal pain or diarrhea
• A severe sore throat
• Sinus pain with yellow mucus
• A painful, burning rash in a band across one side of your body (shingles)
• Painful, widespread mouth sores

Infliximab can reactivate tuberculosis (TB) in people who have been previously infected with TB. Before starting infliximab treatment, you should be screened with a tuberculin skin test and a chest X-ray. If the skin test is positive or the chest X-ray suggests previous exposure to TB, you will need treatment to prevent active TB.

People with rheumatoid arthritis have a slightly higher risk of getting cancer of the lymph glands, called lymphoma, than people without rheumatoid arthritis. But lymphoma is rare even for people with rheumatoid arthritis. Experts do not know why this risk is higher for people with rheumatoid arthritis—it may be because the disease is severe or because of the medicines used to treat it. Studies are currently under way to explain this. Talk with your doctor about the benefits and risks of DMARD therapy.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Infliximab should not be used by pregnant women or women of child-bearing age who are not using reliable birth control. If you are going to take infliximab, you should be on some form of reliable birth control. If you plan to become pregnant, check with your health professional before stopping birth control and trying to become pregnant.

Infliximab is given by an injection (infusion) into a vein (intravenously). An IV is inserted into your arm and the medicine is given slowly over 2 to 4 hours. You will take diphenhydramine and acetaminophen before the infusion to prevent reactions to the infusion such as light-headedness or general discomfort. The first time you get an infusion, it will take a long time because the medicine is given very slowly. Your later infusions will not take as long because the medicine will be infused more quickly. You will get infusions every 4 to 8 weeks. If your symptoms are not improving with infliximab, your doctor may increase your dose or you will get infusions more often.

Because infliximab is a relatively new medication, long-term benefits and side effects are not known.

Infliximab is significantly more expensive than some other DMARDs.

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Author:	Carrie Henley Robin Parks, MS	Last Updated: October 13, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Tom Bailey, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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