Infliximab - Remicade

What is Remicade?
Remicade is a biologic medication approved by the European Agency for the Evaluation of Medicinal Products (EMEA) for the treatment of moderate to severe psoriasis and for the treatment of psoriatic arthritis.

Key Features
• Approved for treating psoriasis and psoriatic arthritis
• Given by three two-hour infusions by a doctor or nurse during the first six weeks of treatment. Infusions repeated every eight weeks after that
• Patients must be screened for tuberculosis (TB) before taking Remicade
• Remicade works more rapidly than other agents for psoriasis, but it may still be 4-8 weeks before any benefit is noticed. About 75% of patients respond to their first course of treatment but later courses may be less effective

How does it work?
Remicade blocks tumour necrosis factor-alpha (TNF-a), a chemical “messenger” in the immune system that signals other cells to cause inflammation. There is too much TNF-a in the skin of people with psoriasis and the joints of people with certain types of arthritis. TNF-a can also lead to increased immune system activity through the activation of T cells. T cells are a type of white blood cell in the body; in psoriasis once T cells are mistakenly activated, they can trigger inflammation and other immune responses and fuel the development of psoriatic lesions.

Remicade helps lower the amount of TNF-a to more normal levels, thus interrupting the inflammatory cycle of psoriasis and psoriatic arthritis and leading to improvement in symptoms for many people who take it.
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Who is it for?
Remicade is indicated for the treatment of adults with severe plaque psoriasis who failed to respond to, or have a contraindication to, or are intolerant to other systemic therapy including Ciclosporin, Methotrexate or PUVA. It is occasionally used to treat rare skin diseases such as pyoderma gangrenosum. It is also widely used in other specialities, for diseases such as rheumatoid arthritis.
Remicade is also indicated for the treatment of active and progressive psoriatic arthritis in adults when the response to previous disease modifying anti-rheumatic drug therapy, and etanercept (Enbrel) has been inadequate.

Who should not take Remicade?
• People with active serious infections or a history of heart failure
• Children – the medication has not been approved for children
· Caution is advised for the elderly, due to the already increased risk of infection for this age group
• Pregnant women should not be treated with Remicade and women should not breastfeed during treatment with Remicade

How is it used?
Remicade comes as a powder that has to be mixed with sterile water and infused into a vein by a doctor or nurse. It will take about two hours for you to receive the full dose of infliximab, and you will usually be asked to wait for a while after the infusion to make sure you do not develop an allergic reaction. An infusion will be given at the start of the course of treatment, and again after 2 and 6 weeks. After that, they are usually given every eight weeks.
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What are the side effects?
Remicade can cause serious allergic reactions during the infusion, and for 2 hours afterwards. For this reason a doctor or nurse will monitor you during this period. You may also be given other medications to treat or prevent reactions to the infliximab.

The most common side effects reported in clinical studies were – infusion reactions (fever, chills, rash), upper respiratory infections, headache, coughing, stomach pain, sore throat, itching.

These events happened most often after the first Remicade infusion and may decrease after additional infusions. These side effects are generally mild and did not cause most patients to stop taking Remicade.

The medication should not be started in someone with an active infection and it may not be recommended for someone with a history of recurring infections. If a serious infection occurs a doctor will most likely stop Remicade.

People should be evaluated for latent (hidden) TB infections by getting a TB skin test prior to treatment with Remicade. Hidden TB must be treated first, before people can begin taking Remicade.

How do I get Remicade?
Remicade will only be prescribed by a Consultant Dermatologist in a hospital dermatology department. It will only be prescribed for those patients for whom all other treatments have failed or are contraindicated.
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