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Infliximab

Chimeric (human constant part, murine variable part) monoclonal antibody against TNFα.

Indications

Crohn's disease resistant to conventional treatment or with fistulae.
Rheumatoid arthritis unresponsive to methotrexate.
Has been tried in UC, but results not so impressive.

Method of administration

Slow intravenous infusion.
Single dose (severe Crohn's disease); three doses (Crohn's with fistulae);
Every 8/52 + methotrexate (rheumatoid arthritis).

Adverse effects

Usually none. Hypersensitivity reactions (urticaria, dyspnoea, hypotension), serum sickness, prone to infection; lupus-like syndrome.

Benefits

Crohn's: reduces need for surgery by 15%. Clinical improvement seen in up to 80% of patients.

Cost

400 per 100 mg vial. 3 mg/kg for RhA is 800, 5 mg/kg for Crohn's is 1200 for a 70 kg man.

Evidence

ATTRACT trial: double blind placebo controlled trial. Infliximab in patients with RhA despite methotrexate. Halts radiographic progression, response maintained at 2 y.