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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 infliximab does have a role in 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.

  • The availability of infliximab depends on the local arrangements within each DHB.

    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.
      • This issue is still unclear but longer term follow-up is very reassuring.
      • Infliximab and adalimumab have been widely used in the USA for several years.

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