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Infliximab (Remicade)
Available:
100 mg in 20 mL vial
Dose:
3-10 mg/kg every 4-8 weeks, administered intravenously in an
outpatient setting or in provider�s office; the first 3
infusions are given at baseline, repeated in 2 weeks, and
again in 4 weeks
Cost:
$1,500-5,000 per infusion, depending on dose given
Indications:
Treatment of severe or refractory rheumatoid arthritis,
ankylosing spondylitis, psoriatic arthritis, or inflammatory
bowel disease; FDA approval pending for treatment of psoriasis
Common To All TNF Antagonists
Side
effects: Injection site reactions
(localized redness and itching) may occur with etanercept or
adalimumab, while infusion reactions (hives or less commonly
shortness of breath) may be seen with infliximab. All of
these medications have been associated with an increased rate
of respiratory infections and may render patients more prone
to other types of infections as well. Individuals with prior
exposure to tuberculosis have experienced recurrences and
disseminated disease in clinical studies. Patients with
pre-existing multiple sclerosis or advanced congestive heart
failure should not take these drugs, as they have been
associated with worsening of these diseases. Rare side
effects include lowered blood counts, elevated liver enzymes,
and drug-induced lupus. Thus far, studies have failed to
demonstrate a link between use of these drugs and solid
cancers. Some concern exists as to an increased risk of
lymphoma, which is difficult to document, as having rheumatoid
arthritis also increases one�s risk for lymphoma.
Monitoring:
A baseline tuberculin skin testing or prior skin test
within one year of starting therapy is recommended. While no
specific guidelines are in place, monitoring blood counts
every 3-6 months and liver function tests every 6-12 months is
reasonable.
Important
points to know: Injection site reactions can be treated
with steroid creams or antihistamines. The site of injection
should also be varied to minimize this problem. Infusion
reactions, if mild, can be managed if patients are pre-treated
with corticosteroids or antihistamines several days prior to
therapy. Any signs of infection should be promptly reported
to your provider.
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