Remicade is approved by Health Canada for adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. It is also approved for psoriatic arthritis, ulcerative colitis and Crohn’s disease.
How Does It Work?
Remicade is an approved monoclonal antibody that binds and neutralizes a messenger protein called TNF (tumour necrosis factor) which is involved in the development of psoriasis. By blocking the effect of TNF, Remicade prevents the body’s autoimmune attack against the skin of those suffering from psoriasis and psoriatic arthritis, ulcerative colitis and Crohn’s disease.
How Is it Administered?
Remicade is given as an intravenous infusion. For psoriasis of the skin the dose is usually 5 mg for every kilogram body weight. Three infusions are given in specialized centres the first six weeks of treatment and then every eight weeks thereafter. Each infusion usually take two to three hours. It must be used continuously for effectiveness.
What are its Side Effects?
Since it is a biologic treatment that suppresses your immune system, patients taking it have a higher chance of catching an infection. Prior to starting treatment with Remicade, your doctor will evaluate you for a tuberculosis infection. Those who have a current TB infection cannot start Remicade. Also patients with congestive heart failure or a personal of family history of demyelinating diseases such as multiple sclerosis must also NOT be give Remicade. Caution is warranted in patients with active serious infections or a history of recurrent infections. Liver damage is also possible with Remicade.
The most frequently reported adverse reaction were mild-moderate upper respiratory infections (e.g.: a runny nose or sore throat).
Special Populations and Remicade
- Pregnant Women: there are no adequate clinical trials on the use of Remicade during pregnancy, however animal studies did not show any harmful effects in pregnancy. The current recommendation is use Remicade during pregnancy only if the benefit justifies the potential risk to the fetus.
- Nursing women: It is not known whether Remicade is excreted in human milk, so caution should be exercised when taking it while nursing.
- Fertility: The effects on human fertility have not been evaluated. However, animal studies did not indicate any harmful effects on fertility.
- Children < 18 years old: The safety and efficacy of Remicade in paediatric patients have not been studied yet, so for this patient population, Remicade is not recommended.
- Elderly patients >65 years old: Limited studies suggest that there is no difference in safety and efficacy between older and younger patients.
- Kidney/Liver Impairment: Remicade has not been studied in these patient populations.
- Some individuals have developed lupus-like symptoms that decreased after their treatment was stopped. Tell your doctor if you develop chest pains that do not go away, shortness of breath, joint pain, or a rash on your cheeks or arms that is sensitive to the sun.
What medications should I pay attention to when on Remicade?
- Remicade suppresses your immune system’s response to infection, which prevents it from releasing your body’s “fighter cells” that help you build an immunity to components of vaccines. For this reason, patients on Remicade (and other biologic medications) cannot have any live vaccine given to them. Some examples are: Influenza nasal vaccine, MMR, Rotavirus, Smallpox, Varicella/Zoster, Yellow Fever, Thyphoid.
- You can and should, however, receive inactivated or non-live vaccinations, such as the yearly influenza vaccine (injectable) and the meningococcal vaccine. Data suggest that Remicade does not suppress your immune system’s response to either of these vaccines.
For detailed information on side effects, safety and if this medication is right for you, please speak to your doctor.