Remicaide and Humira Remecaide and Humira (infliximab and adalimumab) These drugs are antibodies that have been developed to remove one specific molecule responsible for causing inflammation – that is TNF or tumour necrosis factor. This antibody binds specifically to TNF and renders it inactive. The result is a rapid decrease in the inflammation in the bowel. TNF is a major contributor to inflammation in the bowel but is also involved in other diseases, in particular in arthritis. Infliximab and adalimumab are very effective treatment in Crohn's disease (also used in rheumatoid arthritis). Infliximab is given by intravenous infusion. Adalimumab is given by subcutaneous injection How effective is infliximab and adalimumab? After one infusion about 70% of people with Crohn’s disease have had a good response. 1/3 have complete resolution of all symptoms. This effect is observed within 2 weeks. The impressive part about the response to infliximab and adalimumab is the healing of the ulceration seen on colonoscopy. Often the response to steroids and salicylates (5-ASA)seems reasonable but when the colon or small bowel is examined there is still significant ulceration (active disease). Without mucosal healing there is still the chance of complications such as scarring and fistula (see Crohn's disease section). The results for ulcerative colitis are less impressive but still useful infliximab has an important role in the treatment of acute colitis (in-hospital treatment). What about the longer term response? Sustained response is possible with repeated treatments. For infliximab this is an infusion every 2 months - there is a small “drop-off” in effect over time. For adalimumab (Humira) this is a fortnightly subcutaneous injection (easy to learn how to self-administer) maintenance treatment with Humira is now fully funded for selected patients with Crohn's disease. Humira if funded for perianal fistula from Crohn's disease - special criteria apply The availability of infliximab depends on the local arrangements within each DHB. Some patients with ulcerative colitis who have a good response to inpatient treatment will be able to continue with maintenance treatment Other patients with ulcerative colitis who have not responded to other treatments may be able to access infliximab What about side-effects? There is a small risk of infusion reactions. Allergic type reactions - at the time of giving the treatment. This is usually just some flushing or dizziness. The infusion is stopped for a short time and then is usually able to be completed without problems. There has been a lot of concern about the possibility of infections. TNF is an important part of the body’s defence against some infections. In practice the risk of significant infections is about 2%. There are recommendations to have a CXR and skin for TB - particularly if there is any even of previous exposure to tuberculosis. There have been reports of an increased number of cases of lymphoma after infliximab treatment. Longer term follow-up is very reassuring. Infliximab and adalimumab have been widely used for 10-15 years and the safety data has been very encouraging.