Infliximab (Remicade®)

Infliximab (Remicade®) is a chimeric (human-mouse combination) monoclonal antibody that is targeted against TNF-a. Infliximab prevents TNF-a from triggering inflammation in the body by blocking the activities of cell surface receptors. The over stimulation of TNF-a is implicated in causing psoriasis and other autoimmune disorders.

Infliximab is considered to be one of the most potent drugs available to treat psoriasis. It has been approved by the U.S. FDA for the treatment of adult patients with chronic severe plaque psoriasis who are candidates for systemic therapy and when other medicines are either ineffective or unsuitable for use. This drug is also approved to treat other autoimmune disorders, such as Crohn's disease, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, and ulcerative colitis.

How the treatment works

Infliximab binds to TNF molecules in the blood and tissues in the psoriatic plaques and inhibits the activation of cell receptors that trigger the inflammatory symptoms seen in psoriasis.
Administered through intravenous infusion (directly into a vein) by a qualified healthcare professional (a specially trained nurse) in a clinic setting.
Patients must be closely monitored throughout the entire infusion session, which typically lasts 2 hours, then treatment is repeated at weeks 2 and 6 after the first infusion, then every 8 weeks thereafter.
Infliximab is usually given in combination with methotrexate to prevent the formation of antibodies that can make infliximab less effective.

Advantages/Benefits

Treatment is generally well tolerated.
Infliximab exhibits a higher rate of response in comparison to other biologics.
Rapid onset of improvement may be experienced within the first 2-4 weeks of treatment and maximum benefit is generally reached after 10 weeks from the start of therapy.
It is effective for patients who do not respond to other systemic therapies.

Disadvantages/Risks

The most common side-effects include flu-like symptoms, and rashes. A doctor should be monitoring you on a regular basis to ensure safety and treatment efficacy.
In people who have been previously infected with TB, infliximab can cause a reactivation.
Since this is a mouse-human molecule, your body can develop antibodies to the mouse component, which can make the treatment less effective over time. Consequently, dose escalation may be necessary to inhibit the development of antibodies to the drug. Methotrexate can be used to suppress this reaction.

Comments & Suggestions

Before starting treatment, you must be screen for TB with both a tuberculin skin test and a chest X-ray.
Avoid contact with people who have colds, the flu, or other contagious illnesses.
Do not receive a "live" vaccine while you are being treated with infliximab.
The effectiveness of infliximab may be maintained through regular infusions. A regimen involving regular maintenance infusions may reduce the risk of diminished efficacy as has been observed in intermittent "as needed" therapy.
Regular visits to your doctor are required to monitor treatment progress and side-effects.