Remicade (infliximab) is a biologic medicine that helps the pain and swelling of arthritis. It works by blocking TNF (Tumor Necrosis Factor), a type of signalling protein (called a cytokine), that is involved in systemic inflammation. Remicade belongs to a class of similar medications called “Anti-TNF” agents.
Remicade is administered by intravenous infusion at specialized clinics. Patients start by receiving infusions on week 0, week 2, and week 6, and after that, they receive infusions every 6 to 8 weeks depending on their doctor’s prescription. Infusions usually take about 2 hours. Some patients start to feel better quickly with Remicade, but in others, it can take a little longer. Its important for patients starting this medication to give it some time and keep receiving infusions as-prescribed.
A typical starting dose for Remicade is 3-5 mg per kilogram of body weight. The dose may be increased over time.
Remicade may be prescribed in combination with other rheumatology medications like methotrexate.
Important Tests and Risks
Remicade can make it a bit harder for people to fight off infections. Patients taking this medicine should call their doctor they have a fever, think they have an infection, or have been prescribed antibiotics to treat an infection.
Patients should coordinate with their doctor to stop treatment before any surgery, and re-start once things have healed and there’s no sign of infection.
Patients should discuss all vaccinations with their doctor because some are not advisable to receive while taking Remicade.
It is important to have a tuberculosis skin test done and get a chest x-ray before starting Remicade.
Patients who are taking Remicade should have occasional blood tests as requested by their doctor to keep track of their arthritis and make sure that blood counts are ok.
Drug Identification Number (DIN): 02244016 (IV)
How Remicade Works
In some people with arthritis, a type of signalling protein (cytokine) called Tumour Necrosis Factor (TNF) is present in the blood and joints in excessive amounts where it increases inflammation (pain and swelling).
Remicade (infliximab) is another type of protein called a monoclonal antibody that works as a TNF blocker: it blocks the action of TNF.
In blocking TNF, Remicade suppresses the body’s immune system. Though this suppression can make it slightly harder for patients to fight off infections, it also helps to stabilize an overactive immune system.
In patients with arthritis, this medicine can:
- Reduce the pain and swelling (inflammation) in arthritic joints
- Improve day to day function
- Prevent long-term damage caused by joint inflammation
Side Effects of Remicade
Patients taking Remicade (infliximab) should talk to their doctor if they are concerned about any side effects.
MORE COMMON side-effects include:
- Abdominal pain, nausea, vomiting, and diarrhea.
- Back pain, aching joints.
- Rash, flushing.
- Upper respiratory tract infections (such as sinusitis).
RARE side-effects include:
- Infusion Reaction – Some patients may react to the medication during or shortly after it is administered.
- Infection – There is an increased risk of serious infections associated with the use of this medication. Any infections or fevers should be taken very seriously and be reviewed by a doctor.
- Nervous System – There have been very rare reports of some patients developing disorders that affect the nervous system (multiple sclerosis, seizures, or inflammation of the nerves of the eye) while taking Remicade. Fortunately, these reports are exceedingly rare.
- Heart – Patients should inform their doctor if they have congestive heart failure as Remicade may make it worse.
- Malignancy – Remicade has been associated with a small increased risk of developing cancer (<1%).
Who Should NOT Take Remicade
Patients who should NOT be taking Remicade or other brands of infliximab include:
- Patients who have had a previous serious allergic reaction to Remicade
- Women who are pregnant, planning on becoming pregnant, or breast feeding
- Possibly patients who have cancer or have had a past history of certain cancers
- Patients who have congestive heart failure
- Patients who have Lupus or multiple sclerosis
- Patients with active infections (such as tuberculosis)
Anyone who becomes pregnant while taking this medication should tell their doctor.
When to Call a Doctor
Patients taking Remicade should call their doctor if they feel sick and want to stop, or if they are concerned about any side effects.
Other reasons to call a doctor while taking Remicade include:
- Fever or possible infection
- Another doctor has prescribed antibiotics to fight an infection
- Planning for surgery
- Becoming pregnant, or planning on pregnancy
- Planning on any vaccinations
- Developing a rash
Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Remicade.