What is Infliximab (Remicade)?

Infliximab (INN; trade name Remicade) is a monoclonal antibody against TNFα. It is used to treat autoimmune diseases. Remicade is marketed by Centocor in the USA, Mitsubishi Tanabe Pharma in Japan, Xian Janssen in China, and Schering-Plough elsewhere. Centocor was purchased by Johnson & Johnson in 1998 after the initial FDA approval of Infliximab (for Crohn's disease).

Infliximab has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of psoriasis, Crohn's disease, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis and ulcerative colitis. Infliximab won its initial approval by the FDA for the treatment of Crohn's disease in August 1998.

Infliximab works by binding to tumour necrosis factor alpha (TNFα). TNFα is a chemical messenger (cytokine) and a key part of the autoimmune reaction. Originally, it was assumed that Infliximab works by blocking the action of TNFα by preventing it from binding to its receptor in the cell, and for the action of infliximab in rheumatoid arthritis. This still seems to be true. However, another TNFα-neutralizing medication, etanercept (Enbrel), is worse than a placebo in Crohn's disease and thus TNFα-neutralisation is not responsible for its powerful action in the latter disease. As infliximab causes programmed cell death of TNFα-expressing activated T lymphocytes, an important cell type mediating inflammation, but Enbrel does not have this activity, now it is generally assumed that resolution of activated T cells by Infliximab explains its efficacy in Crohn's disease.

Inflixmab is an artificial antibody. It was originally developed in mice, as a mouse antibody. Because humans have immune reactions to mouse proteins, it was later developed into a human (humanized) antibody. Because the antibodies were produced from one cell that was grown into a clone of identical cells, it is called a monoclonal antibody. Because it is a combination of mouse and human antibody, it is called a chimeric monoclonal antibody.

Infliximab was developed by Junming Le and Jan Vilcek at New York University School of Medicine and developed by Centocor.

Infliximab can cost $19,000 to $22,000 a year per patient wholesale, according to Centocor. Remicade is typically covered under major medical insurance (rather than prescription drug insurance).

Other monoclonal antibodies targeting TNFα are golimumab (Simponi), adalimumab (Humira), and certolizumab pegol (Cimzia). Etanercept also binds and inhibits the action of TNFα but is not a monoclonal antibody (it is instead a fusion of TNF-receptor and an antibody constant region).

Infliximab is administered by intravenous infusion, typically at 6-8 week intervals, and at a clinic or hospital. It cannot be administered orally, because the digestive system would destroy the drug.

Further Reading


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Last Updated: Feb 1, 2011

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