What Is Remicade (Infliximab)?
Reviewed by: HU Medical Review Board | Last reviewed: March 2023 | Last updated: March 2023
Remicade® (infliximab) is a biologic treatment option for adults with severe psoriasis. The medicine can also be used to treat adults with psoriatic arthritis, rheumatoid arthritis, and inflammatory bowel diseases1.
Infliximab, the active ingredient in Remicade, is a powerful type of biologic therapy that affects the way the immune system functions to treat the symptoms of psoriasis. It is usually recommended for adults with chronic severe plaque psoriasis (psoriasis lesions on more than 10% of the body), and who have already tried one or more other types of systemic medicines that have not worked well enough or have caused side effects2.
Remicade is a maintenance medicine for treating psoriasis that needs to be taken regularly over a longer period of time to control symptoms effectively. After an initial induction dose, patients take Remicade through an IV infusion in a healthcare provider’s office, usually once every 8 weeks3.
How does Remicade (infliximab) work to treat plaque psoriasis?
Psoriasis is a chronic autoimmune condition with skin symptoms caused by inflammation inside the body. Certain proteins in the immune system called cytokines play an important role in triggering and sustaining inflammation. People with psoriasis may have an overactive immune system, which causes inflammation that triggers the production of too many new skin cells. The new skin cells are produced at a rate that is quicker than older skin cells can shed, so they build up on the surface of the skin and cause plaques to form.
Infliximab is a drug engineered in the laboratory from human and mouse molecules. It is designed to seek out and bind to TNF-alpha, breaking the cycle of inflammation and thus the reducing psoriasis symptoms that the inflammation causes2.
Clinical studies have demonstrated that infliximab can be effective for many patients with psoriasis. After 10 weeks of treatment, around 80% of patient have an improvement in psoriasis symptoms of at least 75%3.
Who can take Remicade (infliximab)?
Remicade is approved for adults with severe psoriasis who are 18 years of age and older. It is not suitable for treating patients with an untreated chronic infection (such as tuberculosis or hepatitis), or for patients with moderate or severe heart failure.3
Prior to prescribing Remicade, healthcare providers need to know if the patient4:
- has an infection, has any signs of an infection, or gets infections regularly
- has any open cuts or sores
- has diabetes or other immune system problems
- has a history of Crohn’s disease or ulcerative colitis
- has tuberculosis or has been in contact with anyone who does (patients will be monitored for TB prior to starting treatment and during treatment)
- has or has had hepatitis B
- has any liver problems
- has heart failure, or any other heart condition
- has or has had cancer
- has had phototherapy treatment for psoriasis
- has chronic obstructive pulmonary disease (COPD)
- has any nervous system condition (such as multiple sclerosis)
- has recently had a seizure
- has lived in a part of the country where certain types of fungal infections are more common
- has recently had a vaccine, or has a vaccine scheduled
- is pregnant, planning to become pregnant, breastfeeding or has had a baby within the last 6 months
Let your healthcare provider know about any medicines, vitamins or supplements you are taking, but especially4:
- Kineret (anakinra)
- Orencia (abatacept)
- Actemra (tocilizumab)
- any biologic therapies
How is Remicade (infliximab) administered?
Patients take Remicade through an IV infusion in a healthcare provider’s office. Each infusion takes around 2 hours to complete, with the patient being monitored for side effects throughout the infusion3.
Generally, a patient will receive two more infusions over the next 6 weeks. If the medicine is having an effect on the psoriasis symptoms, then patients will usually receive an infusion every 8 weeks4.
What are the side effects and risks of taking Remicade (infliximab)?
The most common side effects linked to treatment with Remicade include3:
- respiratory infections
- stomach pain
Some people develop reactions caused by the infusion, which can happen up to two hours after the infusion3. Patients are monitored for these types of reactions after the infusion.
Remicade is a very powerful medicine that can cause very serious side effects in some patients due to the effect that it has on the way their immune systems work. It can reduce the immune system’s ability to fight off viral, bacterial, and fungal infections that can be dangerous or even life-threatening. If the patient has had hepatitis B, taking Remicade can make the virus active again. Tell your healthcare provider right away if you develop any signs or symptoms of infections, such as fever, cough, or flu-like symptoms. As with other TNF-alpha blockers, Remicade may slightly increase the patient’s risk of developing certain types of cancers, including lymphoma and skin cancers4.
Other serious side effects experienced by a small number of people treated with Remicade include4:
- heart failure
- liver problems
- blood problems
- nervous system disorders
- allergic reactions
- lupus-like syndrome
- worsened psoriasis symptoms
Patients are monitored throughout treatment with Remicade using blood and laboratory tests to check for signs of serious side effects.
Remicade has a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). It has this warning because:
- It can increase your risk of serious infections
- Cancer has been reported in people treated with Remicade
These are not all the possible side effects of Remicade. Talk to your doctor about what to expect when taking Remicade. You also should call your doctor if you have any changes that concern you when taking Remicade.
Can Remicade (infliximab) be used with other treatments or drugs?
Patients’ healthcare providers will advise them about other types of psoriasis treatments they can use during treatment with Remicade. Topical treatments and methotrexate, another type of systemic medicine, can be combined with Remicade for many patients. Combined treatment with cyclophosphamide, azothioprine or mercaptopurine may not be recommended.