Infliximab (Remicade)

Monoclonal antibody targeted to TNF.

Targets both soluble and transmembrane TNF.

Intravenous infusion given every 4-8 weeks with a half-life of 8-12 days.

Associated with infections and should be used with caution in patients predisposed to infection or with recurrent infections.

Associated with increased risk of tuberculosis and all other granulomatous diseases including candidiasis, listeriosis and norcardiosis.

Use associated with increased risk of mycobacterial, viral and fugal infections.

Risk of infections higher than with etanercept.

Range of lymphomas diagnosed is 0.2-1.4% of patients with Crohn’s disease treated with infliximab.

In patients with treated with Crohn’s disease and rheumatoid arthritis the overall incidence of lymphomas is 0.6%.

Lymphomas that occur with treatment are predominantly large B cell lymphomas that are positive for EBV.

Effective for short-term treatment of patients with moderate to severely active Crohn’s disease or draining enterocutaneous fistulas, and sustained benefit with retreatment every 8 weeks.

In a randomized control study of infliximab monotherapy, azathioprine monotherapy and the combination of the two drugs in 508 patients with moderate to severe Crohn’s disease: patients treated with infliximab plus azathioprine, or onfliximab monotherapy were more likely to have a corticosteroid free clinical remission than those receiving azathioprine mootherapy (Study of biologic and Immunomodulator Naive Patients in Crohn’s Disease (SONIC) Study Group).

Beneficial for induction and maintenance treatment of ulcerative colitis.

In combination with methotrexate, is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis.

Has efficacy in both early (>3 months and ≤3 years) and established moderately to severely active RA.

In early RA, results were noted in some patients within 2 weeks after the first infusion, and the majority of patients demonstrated clinical response at 54 weeks.

The recommended dose is 3 mg/kg given as an intravenous induction regimen at 0, 2, and 6 weeks, followed by a maintenance regimen of 3 mg/kg every 8 weeks thereafter for the treatment of moderately to severely active RA.

Should be given in combination with methotrexate.

Lack of response to TNF inhibitors has been attributed to an immune response against the drug, leading to the formation of anti-drug antibodies.
Anti-bodies against TNF Inhibitors reduce serum drug levels and are associated with adverse effects such as infusion reactions.
Infliximab chimeric antibody is more immunogenic than other TNF Inhibitors, and anti-body formation is particularly common during initiation of this drug.

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