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 tumor 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

The most common side effect of TNF antagonists, such as infliximab, is an allergic reaction to the infusion (medicine given in a vein—intravenously, or IV). If you have a reaction to the infusion, it will happen right away, either during the infusion or within 1 to 2 hours after the infusion. Your doctor may give you medicines to prevent or stop the reaction.

Symptoms of an infusion site reaction include:

  • Fever.
  • Chills.
  • Chest pain.
  • Shortness of breath.
  • Itching (pruritus).
  • Headache.
  • Nausea.
  • Heat and redness (flushing) in the face.
  • Rash.
  • Fatigue.
  • Dizziness.

Warnings about serious side effects of TNF antagonists have been issued. The U.S. Food and Drug Administration (FDA) and the drug’s manufacturers have warned about:

  • An increased risk of a serious infection. TNF antagonists affect your body's ability to fight all infections. So if you get a fever, cold, or the flu while you are taking this medicine, let your doctor know right away.
  • An increased risk of blood or nervous system disorders. Call your doctor if you have symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
  • A possible increased risk of lymphoma (a type of blood cancer). It is not clear whether this increase is because of the drug or because people with this disease may already have a higher risk. There have been reports of a rare kind of lymphoma, occurring mostly in children and teens taking TNF antagonists, that often results in death.
  • An increased risk of liver injuries. Call your doctor if your skin starts to look yellow, if you are very tired, or if you have a fever or dark brown urine.

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 childbearing 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 lightheadedness 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.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Kwoh CK, et al. (2002). Guidelines for the management of rheumatoid arthritis. Arthritis and Rheumatism, 46(2): 328–346.

Last Updated: August 18, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Anne C. Poinier, MD - Internal Medicine & Stanford M. Shoor, MD - Rheumatology

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