Uses of Remicade: - Rheumatoid arthritis - Ankylosing spondylitis - Psoriasis - Psoriatic arthritis - Ulcerative Colitis - Crohn’s disease Crohn's disease, Rheumatoid arthritis, Ulcerative colitis, Ankylosing spondylitis, Psoriatic arthritis, Plaque psoriasis Patient w/ TB or other severe infections (e.g. sepsis, abscesses, opportunistic infections), moderate or severe heart failure (NYHA class III or IV).

Targeted Cancer Therapy

Infliximab neutralizes the biological activity of TNFα by binding with high affinity to the soluble and transmembrane forms of TNFα and inhibits binding of TNFα with its receptors. Infliximab does not neutralize TNFα (lymphotoxin-α), a related cytokine that utilizes the same receptors as TNFα. Biological activities attributed to TNFα include: induction of pro inflammatory cytokines such as interleukins (IL) 1 and 6, enhancement of leukocyte migration by increasing endothelial layer permeability and expression of adhesion molecules by endothelial cells and leukocytes, activation of neutrophil and eosinophil functional activity, induction of acute phase reactants and other liver proteins, as well as tissue degrading enzymes produced by synoviocytes and/or chondrocytes. Cells expressing transmembrane TNFα bound by infliximab can be lysed in vitro or in vivo. Infliximab inhibits the functional activity of TNFα in a wide variety of in vitro bioassays utilizing human fibroblasts, endothelial cells, neutrophils, B and T lymphocytes and epithelial cells. The relationship of these biological response markers to the mechanism(s) by which Infliximab exerts its clinical effects is unknown. Anti-TNFα antibodies reduce disease activity in the cotton-top tamarin colitis model, and decrease synovitis and joint erosions in a murine model of collagen-induced arthritis. Infliximab prevents disease in transgenic mice that develop polyarthritis as a result of constitutive expression of human TNFα, and when administered after disease onset, allows eroded joints to heal.

How to use Infliximab: Your doctor or nurse will give you this medicine. Kindly do not self administer. Adult Dose: Intravenous Crohn's disease Adult: Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk after 1st infusion. No further doses should be given if there is no response after 2 doses. Responders: Maintenance: 5 mg/kg at 6 wk after initial dose then 8 wkly thereafter. May be re-administered w/in 16 wk after last infusion if signs/symptoms recur. Rheumatoid arthritis Adult: In combination w/ methotrexate: Initially, 3 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk after 1st infusion then 8 wkly thereafter. May increase dose in increments of 1.5 mg/kg to a max of 7.5 mg/kg 8 wkly if patient has inadequate response or loses response over a period of 12 wk. Alternatively, 3 mg/kg 4 wkly. May be re-administered w/in 16 wk after last infusion if signs/symptoms recur. Fistulising Crohn's disease Adult: Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk after 1st infusion. No further doses should be given if there is no response after 3 doses. Responders: Maintenance: 5 mg/kg 8 wkly. Re-admin: 5 mg/kg if signs/symptoms recur, followed by 5 mg/kg 8 wkly. Ankylosing spondylitis Adult: Initially, 5 mg/kg, repeated at 2 wk and 6 wk, then 6-8 wkly thereafter. Stop treatment if there is no response after 2 doses. Ulcerative colitis Adult: Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk after 1st infusion then 8 wkly thereafter. No further doses should be given if there is no response after 3 doses. Psoriatic arthritis; Plaque psoriasis Adult: Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk, then 8 wkly thereafter. Stop treatment if there is no response after 12 wk for psoriatic arthritis and after 14 wk for plaque psoriaris. Child Dose: Intravenous Crohn's disease Child: 6-17 yr Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk after 1st infusion then 8 wkly thereafter. Ulcerative colitis Child: 6-17 yr Initially, 5 mg/kg by infusion over 2 hr, repeated at 2 wk and 6 wk after 1st infusion then 8 wkly thereafter.

Increased risk of serious infection and neutropenia w/ anakinra or abatacept. Risk of clinical infections, including disseminated infections w/ concurrent admin of live vaccines.

Patient w/ TB or other severe infections (e.g. sepsis, abscesses, opportunistic infections), moderate or severe heart failure (NYHA class III or IV).

Common - Headache - Sinus inflammation - Upper respiratory tract infection - Infusion reaction - Abdominal pain - Sore throat

Pregnancy Category B. It is not known whether Infliximab can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.It is not known whether Infliximab is excreted in human milk or absorbed systemically after ingestion. Because many drugs and immunoglobulins are excreted in human milk, and because of the potential for adverse reactions in nursing infants from Infliximab, women should not breast-feed their infants while taking Infliximab.

Precaution: Patient w/ mild heart failure (NYHA class I or II), history of blood dyscrasias, chronic or recurrent infection. Childn. Pregnancy and lactation. Patient Counselling This drug may cause dizziness, if affected, do not drive or operate machinery. Monitoring Parameters Monitor for signs and/or symptoms of infection, hypersensitivity reaction, lupus-like syndrome, heart failure, malignancy. Monitor vital signs every 2-10 min if reaction is noted during infusion. Perform hepatitis B virus screening prior to and hepatitis B virus carriers during and several mth after therapy; CBC w/ differential, LFTs.

Infliximab must be refrigerated at 2ºC to 8ºC. Do not use Infliximab beyond the expiration date (Exp) located on the carton and the vial. This product contains no preservative.

Targeted Cancer Therapy

Infliximab is a chimeric monoclonal antibody which binds w/ high affinity to the soluble and transmembrane forms of tumour necrosis factor-α (TNF-α) thereby inhibiting binding of TNF-α to its receptors.

Pregnancy Category B. It is not known whether Infliximab can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.It is not known whether Infliximab is excreted in human milk or absorbed systemically after ingestion. Because many drugs and immunoglobulins are excreted in human milk, and because of the potential for adverse reactions in nursing infants from Infliximab, women should not breast-feed their infants while taking Infliximab.