Infliximab

A Review of its Use in Crohn’s Disease and Rheumatoid Arthritis

Siddiqui, M Asif A
Scott, Lesley J

Adis International Limited, Auckland, New Zealand

Various sections of the manuscript reviewed by:H. Asakura, International Medical Information Center, Shinjukuku, Tokyo, Japan; F. Breedveld, Department of Rheumatology, Leiden University Hospital, Leiden, The Netherlands; T. Ikawa, Osaka Rehabilitation Hospital, Osaka, Japan; P.J. Rutgeerts, Gastroenterology Section, Faculty of Medicine, University of Leuven, Leuven, Belgium; S. Schreiber, Department of General Internal Medicine and Institute for Clinical Molecular Biology, Christian-Albrechts-University, Schittenhelmstrasse, Kiel, Germany; W.S. Selby, Department of Medicine, University of Sydney, Sydney, Australia; G. Valesini, Division of Rheumatology, La Sapienza University, Rome, Italy.

Correspondence: M. Asif A. Siddiqui, Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland 1311, New Zealand. E-mail: [email protected]

Drugs 65(15):p 2179-2208, 2005.

Infliximab (Remicade^®) is a chimeric monoclonal antibody against tumour necrosis factor (TNF)-α that has shown efficacy in Crohn's disease and rheumatoid arthritis with a disease-modifying activity and rapid onset of action. It is administered intravenously, generally in a schedule with initial infusions at 0, 2 and 6 weeks, followed by administration once every 8 weeks.

Infliximab is effective in the treatment of patients with moderately to severely active Crohn's disease with an inadequate response to other treatment options or those with fistulising disease. In combination with methotrexate, infliximab reduced signs and symptoms and delayed disease progression in patients with active, methotrexate-refractory rheumatoid arthritis and in those with early disease. The drug was generally well tolerated. Recrudescence of tuberculosis infection and worsening of heart failure and demyelinating disease are among some of the concerns with anti-TNFα therapy, requiring cautious use of these agents in high-risk patients.

Current data suggest that infliximab may be cost effective, especially when long-term clinical outcomes and burden of the diseases are taken into account. More robust, prospective pharmacoeconomic studies are required to better ascertain the cost effectiveness of infliximab.

Direct head-to-head comparative trials of infliximab with other biological agents are not yet available and would be helpful in determining with greater certainty the place of infliximab in the management of these diseases. Nonetheless, infliximab, like other biological agents, is a valuable treatment option in patients with moderately to severely active Crohn's disease (including fistulising disease) or rheumatoid arthritis (including early disease).