Treatment > Medications

Remicade – For inflammatory bowel diseases

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Remicade is a medication that is used as a solution for infusion. It contains the antibody infliximab. Infliximab is a monoclonal antibody that is used in advanced therapy for inflammatory bowel disease. Infliximab helps control inflammation of the intestine by rendering the messenger substance tumor necrosis factor alpha (TNFα) harmless.

At a glance

Tumor necrosis factor alpha (TNFα) is an inflammation mediator that immune cells produce. TNFα is involved in inflammatory events with inflammatory bowel disease. Infliximab is a monoclonal antibody against TNFα. Infliximab binds and neutralizes TNFα.

What is Remicade?

Remicade is a solution for infusion that contains the antibody infliximab. Infliximab is a monoclonal antibody against the inflammatory substance tumor necrosis factor alpha (TNFα).TNF is produced by immune cells and is an important mediator of chronic intestinal inflammation. The antibody consists partly of human proteins and those that resemble the proteins found in mice.

How does infliximab work?

Immune cells produce the inflammatory mediator TNFα, which is an important mediator of chronic intestinal inflammation. Infliximab binds TNFα and neutralizes it. That is, it renders the inflammation mediator harmless and it loses its effect. This weakens the inflammation of the intestine.

What should my doctor check before using Remicade?

Before starting Remicade therapy, your doctor should rule out tuberculosis. Because the therapy could reactivate tuberculosis and lead to serious symptoms. The doctor should also check your vaccination status and if necessary updated your shots against the causative agents of tetanus or diphtheria. As a rule, this vaccination protection should be renewed every ten years.

How is Remicade administered?

Remicade is a solution for infusion. After applying a peripheral venous catheter (PVK) - a special form of an intravenous catheter - Remicade can be administered directly into the vein. The duration of the infusion is approximately 2 hours.

For those interested: How do you apply a peripheral venous catheter? The placement of a peripheral venous catheter is similar to taking a blood sample. The backflow of blood is prevented by a tourniquet, so that the veins are more visible and palpable. After thorough skin disinfection, the actual puncture of the vein takes place. The catheter is then pushed further into the vein via the puncture needle and the needle is withdrawn. This leaves nothing sharp or pointed in your vein that could hurt you. The catheter is fixed with a plaster and the tourniquet is loosened. The catheter is then rinsed with a little saline solution to check its position and function.

How much does therapy with Remicade cost?

An infusion solution Remicade (infliximab) costs 600-700 € depending on the manufacturer. Extrapolated to one year, the average is € 3600-4200. As a patient with a valid prescription, however, you only pay a co-pay of € 10 at the pharmacy in Germany.

I have Crohn's disease - when can I use Remicade therapy?

Treatment with Remicade for Crohn's disease is possible if treatment with glucocorticoids is no longer effective or cannot be continued. At the beginning you get an infusion every two weeks. If the therapy works well, a new infusion therapy is done every eight weeks. Alternatively, the Remicade therapy is paused and, in the event of renewed complaints, administered again every eight weeks. The break should not be longer than 16 weeks. Therapy is similar for children and adolescents. The receive Remicade again after two and six weeks.

If the symptoms do not improve after the second dose of Remicade or after six weeks, the therapy is usually stopped.

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I have ulcerative colitis - when can I be treated with Remicade?

Remicade therapy for ulcerative colitis is possible if glucocorticoids, 6-mercaptopurine and azathioprine no longer work. The Remicade dose is repeated two and six weeks after the initial dose. If the symptoms improve, the infusion is then carried out every eight weeks. If the symptoms do not improve, further therapy should be checked after the third dose or after eight weeks. Therapy is similar for children and adolescents. They receive the repeated administration of Remicade or Infliximab after two and six weeks.

How quickly does the antibody infliximab work?

Therapy with Remicade (infliximab) leads to no immediate improvement of the symptoms. Usually it takes four to eight weeks and two to three infusions to evaluate the effect. For detailed information, also see the articles on Crohn's disease and ulcerative colitis.

Overview: When and how will I be treated with Remicade? Remicade is used when previous therapy with corticosteroids or immunosuppressants (azathioprine, 6-mercaptopurine) has failed. Remicade will be re-administered two and six weeks after the first dose. The drug usually works within six to eight weeks. If the symptoms do not improve after eight weeks or after three infusions, one should rethink the continuation of the therapy.

Who shouldn't be treated with Remicade or infliximab?

Patients who already demonstrate a hypersensitivity reaction against proteins, should not receive the drug Remicade or the antibody infliximab. It should also be avoided in patients with serious infections, such as sepsis or tuberculosis. The medicine should also be avoided with moderate or severe heart failure.

What are the side effects of Remicade?

Remicade can trigger a hypersensitivity reaction (allergy). The risk of a hypersensitivity reaction increases with the duration of the therapy break. Severe allergic reactions can cause shock, which requires emergency treatment.

Since the antibody infliximab blocks the important inflammation mediator TNFa, this increases the risk of infection during therapy. Virus infections such as the flu or bacterial infections can often occur.

Important: What do I have to consider under a Remicade treatment? Remicade / infliximab weaken the immune system. Tuberculosis must be excluded before therapy begins. Therapy with Remicade increases the risk of infection.

Can I eat anything during Remicade therapy?

In principle, it is possible to eat all foods during Remicade therapy. With raw foods such as raw milk cheese or sushi, there is an increased risk of infection. Listeria are bacteria that trigger the disease listeriosis. This disease can be caused by eating raw milk cheese. If current hygiene rules are observed, this risk of infection is very low.

In many cases, the right nutrition is crucial both in reducing symptoms and increasing quality of life. Please have a look at our nutritional medical therapy program. (Limited spaces) - developed and recommended by doctors. Our certified nutritionists will be happy to help you:

  • Find out which foods you shouldn't combine with Remicade therapy
  • What foods you don't get at home
  • Increase your quality of life and reduce your symptoms

Start your self-test here and get a free initial consultation with one of our experts, conveniently online from home. In the further course, up to 5 sessions will be reimbursed by your health insurance in Germany.

Can Remicade lose its effectiveness?

It is possible that your own body makes antibodies against Remicade (infliximab). On the one hand, these weaken the therapeutic effect of the drug, and on the other hand, they also increase the risk of an allergic reaction. The detection of these antibodies in the laboratory is not always successful. Successful detection, however, can explain a possible ineffectiveness of therapy and forms the basis for a possible change of therapy in order to avoid allergic reactions.

What can I do if Remicade stops working?

If therapy with Remicade loses its effect, an increase in the dosage and also the shortening of the infusion intervals can improve the effect. You can also attempt therapy with adalimumab. Adalimumab is also a monoclonal antibody to TNFα; however, it has only human components. Both the response to therapy and the frequency of side effects of infliximab and adalimumab are similar.

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Singh, S., Andersen, N.N., Andersson, M., Loftus Jr, E.V. and Jess, T., 2018. Comparison of infliximab with adalimumab in 827 biologic‐naïve patients with Crohn's disease: a population‐based Danish cohort study. Alimentary pharmacology & therapeutics, 47(5), pp.596-604. Downloaded on 21.09.2018 from: https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.14466

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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