Crohn's disease is an inflammatory bowel disorder that can cause debilitating effects on the intestines. Doctors treat Crohn's disease with medications that reduce inflammation or modify the immune system to try to prevent it. Remicade, the brand name of the drug infliximab, treats Crohn's disease by blocking one component of the immune system, with powerful positive and negative effects.
Use
The National Institute of Diabetes and Digestive and Kidney Disorders says that infliximab is the first medication approved to specifically treat Crohn's disease. The U.S. Food and Drug Administration approved infliximab to treat more severe cases of Crohn's disease that do not respond to the standard medications such as immune suppressors or anti-inflammatory drugs. Infliximab can also treat open fistulas, which are ulcers that penetrate all the way through the walls of the intestines.
Mechanism
Rather than reducing the effects of inflammation, infliximab works by directly suppressing the immune response. Infliximab is an antibody that targets a protein in the bloodstream called tumor necrosis factor or TNF, a key figure in the immune response that recruits many other components of the immune system. Infliximab binds to and inactivates TNF to prevent inflammation in the digestive tract. Supression of the immune system makes infliximab a powerful drug to treat Crohn's disease, but it also exposes the patient to serious potential consequences.
Cancer
According to the Merck Manual, the U.S. Food and Drug Administration, or FDA, issued a warning that children and teens who take infliximab or other TNF-blocking drugs have an increased risk of developing lymphoma, a form of cancer that affects the lymphatic system, after doctors reported 48 cases of cancer in their young patients using these drugs. About half of the patients who developed cancer had lymphoma, while many others had types of cancers that are usually very rare in children. Patients of any age who take infliximab or other TNF-blockers might have an increased risk for leukemia, a cancer of the blood cells.
Other
Because infliximab suppresses the immune system, patients have an increased risk of developing serious bacterial, viral and fungal infections that require hospitalization. Due to the serious nature of this risk, the FDA mandated that boxes of infliximab carry this warning:
Patients using infliximab and other TNF blockers have an increased risk of developing the skin disease psoriasis. Latent tuberculosis infections can reactivate, and uninfected patients have increased risk for catching tuberculosis.
Infliximab can affect the liver, causing jaundice or reactivating a latent hepatitis B infection. Less serious potential side effects include nausea, fatigue and headache.
Warning
The Mayo Clinic cautions that certain groups of people cannot take infliximab. Patients with current cancer or a history of cancer, multiple sclerosis, or heart failure should not take infliximab or similar drugs. Patients with active tuberculosis cannot take infliximab. People who might have been exposed to tuberculosis should have a skin test and chest x-ray to rule out infection before taking infliximab.
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