Remicade is a biological drug whose active ingredient is infliximab. It reduces inflammation driven by the immune system.

It is used particularly in the treatment of inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis. It is also used in some rheumatic diseases and in psoriasis.

Remicade is not a steroid (cortisone) or an antibiotic. It is not addictive.

How does Remicade work?

In Crohn’s disease and ulcerative colitis, the immune system causes long-lasting inflammation in the bowel.

One of the substances that plays a part in this inflammation is a protein called TNF-alpha.

Remicade blocks the effect of the protein TNF-alpha and so reduces the inflammation in the bowel.

In this way it can help reduce complaints such as abdominal pain, diarrhoea and bloody stools, help the sores on the bowel lining heal, and keep the disease under control.

Remicade does not get rid of the disease completely; it aims to keep the inflammation under control.

What is it used for?

Crohn’s disease

Crohn’s disease is a chronic inflammatory bowel disease that can affect different parts of the digestive system, from the mouth to the anus.

Remicade can be used particularly in moderate to severe active Crohn’s disease.

The aims of treatment are to reduce the symptoms, bring the inflammation in the bowel under control and lower the risk of the disease flaring up again.

Crohn’s disease with fistulas

In Crohn’s disease, abnormal connections can sometimes form between the bowel and the skin, or between other tissues. These are called fistulas.

Fistulas that develop around the back passage in particular can cause pain, discharge and repeated abscesses.

In suitable patients, Remicade can help reduce fistula discharge and help fistulas close.

However, treating fistulas sometimes also needs surgery, drainage of an abscess or placement of a seton.

If there is an abscess, giving a biological drug alone is not enough.

Ulcerative colitis

Ulcerative colitis is a chronic disease that causes inflammation of the inner lining of the large bowel.

Remicade can be used particularly in some patients with moderate to severe active ulcerative colitis.

In some severe flare-ups, if the first treatments given in hospital do not work well enough, it can be one of the rescue treatment options.

Other diseases

In suitable patients, infliximab can also be used to treat rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and plaque psoriasis.

The decision to treat these diseases is made by the relevant specialist.

How is Remicade given?

Remicade is given as an infusion into a vein, in a hospital or a suitable healthcare facility.

It is not a tablet taken by mouth.

The starting schedule commonly used in inflammatory bowel diseases is a first dose followed by repeat doses at weeks 2 and 6.

In patients who respond to treatment, it is then usually continued every 8 weeks.

However, the dose and the intervals can be changed according to the state of the disease, the patient’s weight, the response to treatment and, where needed, drug levels.

A standard infusion usually takes about 2 hours. In suitably selected patients, shorter infusions may be possible, depending on the product’s instructions and the centre’s protocol.

During and after the infusion the patient is watched for possible reactions.

How long does Remicade take to work?

In some patients the symptoms improve after the first infusions.

However, assessing the effect of treatment usually needs a few weeks of follow-up.

Not every patient responds in the same way. In some patients the effect may not be enough, or the drug may become less effective over time.

Which tests are done before Remicade treatment?

Because Remicade suppresses a particular part of the immune system, patients should be assessed for infections before treatment.

In particular:

Tuberculosis screening: The assessment is made with the patient’s history, the necessary blood or skin tests and suitable imaging.
Hepatitis B screening: Blood tests are done for current or past hepatitis B infection.
Other infections: Further assessments may be needed depending on the patient’s condition.
Vaccines: The vaccination history is reviewed and suitable vaccines are completed before treatment where possible.

Treatment should not be started in patients with an active, serious infection.

What are the side effects of Remicade?

Remicade is an effective treatment in many patients. However, it can cause some side effects.

Reactions during the infusion

While the drug is being given into the vein, or shortly afterwards, some patients may have:

Itching
Redness of the skin
Headache
Fever or shivering
Shortness of breath
Changes in blood pressure

Rarely, serious allergic reactions can develop. For this reason the drug is given under the supervision of healthcare staff.

Infections

Remicade can increase the risk of catching some infections.

Of particular importance are tuberculosis becoming active again, hepatitis B reactivating, and some serious bacterial or fungal infections.

If fever, a long-lasting cough, shortness of breath or clear signs of infection develop during treatment, talk to your doctor.

Less common but important side effects

Liver damage
A fall in blood cells
Worsening of heart failure
Some diseases of the nervous system
Drug-induced lupus-like reactions
A higher risk of some types of cancer

Assessing the risk of lymphoma and some skin cancers in particular is important. However, some of these risks may also be linked to the disease itself and to other immunosuppressive drugs used alongside.

What should I watch out for while having Remicade?

The infusions should be given at the intervals your doctor sets.
If you have a fever or signs of a serious infection, tell the healthcare team before the infusion.
Do not neglect the tuberculosis and hepatitis B screening.
Ask your doctor’s advice about live vaccines.
If you take other immunosuppressive drugs, tell your doctor.
Regular clinical and laboratory check-ups should be done during treatment.

Can Remicade become less effective over time?

Yes. In some patients, although the response is good at first, the treatment becomes less effective over time.

One of the reasons for this is the body developing antibodies against the drug.

Where needed, the infliximab level in the blood and antibodies against the drug can be measured.

Depending on the results, the doctor may change the interval between doses, plan additional treatment or switch to a different drug.

Remicade and biosimilar drugs

Apart from Remicade, there are other infliximab products called biosimilars.

Biosimilar drugs are products that must be highly similar to the reference biological drug in quality, effectiveness and safety.

Being a biosimilar does not mean that a drug is ineffective or of lower quality.

Which product is used is decided taking into account the current licensing conditions and the patient’s condition.

Can it be used in pregnancy and breastfeeding?

Infliximab is not a drug that is strictly forbidden in pregnancy in every situation.

In some patients with Crohn’s disease or ulcerative colitis, continuing treatment during pregnancy may be appropriate to keep the disease under control.

However, in babies exposed to the drug during pregnancy, the timing of some live vaccines may change.

For this reason, pregnancy planning, continuing treatment during pregnancy and the baby’s vaccination schedule should be assessed together with the gastroenterologist and the obstetrician.

During breastfeeding, too, an individual assessment should be made.

The drug should not be stopped without a doctor’s advice.

Frequently asked questions

Is Remicade a steroid (cortisone)?

No. Remicade is not cortisone. It is a biological drug that targets the inflammatory messenger called TNF-alpha.

Is Remicade addictive?

No. It is not addictive. However, long-term treatment may be needed to keep the chronic disease under control.

Is Remicade chemotherapy?

It is not cancer chemotherapy. It is a biological treatment that targets a particular part of the immune system.

Is Remicade given to every patient with Crohn’s disease?

No. The decision is made by assessing the severity of the disease, how widespread the inflammation in the bowel is, any complications and the treatments used before.

What should I do if an infection develops while I am on Remicade?

If a fever or signs of a serious infection develop, talk to your doctor. Treatment may need to be postponed during a serious infection.

How long is Remicade used for?

The length of treatment depends on the state of the disease and the response. Some patients take it for many years. The decision to stop treatment should be made by the doctor.

Important: This page has been prepared to give general health information. Remicade is a biological treatment planned by a specialist that needs regular follow-up. Infection screening, the infusions and treatment decisions should be carried out under a doctor’s supervision.