People with psoriasis and psoriatic arthritis can produce increased amounts of an important protein (cytokine) known as tumor necrosis factor-alpha or TNF-alpha, which can cause the red, scaly, raised areas of the skin and tender, swollen joints. TNF-alpha is found in higher than normal amounts in the affected skin and joints and can trigger inflammation in these areas. Blocking this inflammatory messenger can reduce inflammation of the joints in psoriatic arthritis, and prevent and treat the appearance of skin lesions in psoriasis.
Three biologic agents, etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade), block TNF-alpha and are currently approved in the United States and Canada for the treatment of psoriatic arthritis and psoriasis. These agents can neutralize the undesirable inflammatory effects of TNF-alpha in the skin and joints.
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| Infliximab Psoriasis Infusion |
Infliximab (in-fliks-ih-MAB) (Remicade)
Infliximab is a biologic drug that binds and blocks TNF-alpha. As noted earlier, biologic drugs are made from living cells, such as viruses, animal cells, and human cells. A small portion of infliximab is derived from mice. lnfliximab is a very selective agent that localizes at the site of inflammation in the skin and blood vessel walls. It is able to kill cells that have TNF-alpha on their surfaces and acts like a sponge, soaking up TNF-alpha and removing it from the body's circulation.
How Is lnfliximab Given?
The drug is given by intravenous infusion over about a 2-hour period. It is administered by a trained health care professional either in a private clinic or in a hospital. There are four steps to the infusion process.
1. Before you start infliximab: Your doctor will review with you the risks, benefits, side effects, and alternatives. Your doctor might give you an informed consent form outlining these risks and benefits. You are entitled to review this document on your own, and with our doctor or nurse, and sign it if you are comfortable with what you have read, heard, and discussed with your health care providers.
The intention is to give you an additional opportunity to review the risks, benefits, and alternatives before you start treatment. You will need some blood work done, a tuberculosis skin test, and possibly a chest X-ray prior to starting the medication.
2. Day of the infusion: When you arrive at the infusion clinic or hospital, a nurse will check all your vital signs, such as temperature, blood pressure, and heart rate, before administering infliximab.
3. Infusion: You will sit in a chair and a trained professional will insert a small needle into your arm. This may create a slight pinching sensation, which is only temporary. A small narrow tube called a catheter will replace the needle. The medication travels from a small bag through tubing into the catheter and into your arm. It is important not to make any sudden movements or the catheter may be dislodged from your arm.
4. During the infusion: Your nurse will regularly monitor your progress, check your vital signs, and ensure you are tolerating the therapy well. During this time, you can relax, read or, in some clinics, watch television. If you develop any of the following, you should notify your doctor or nurse immediately: hives/rash; wheezing or tightness in your chest; or swelling of your eyelids, face, or lips.
If you develop such symptoms, your doctor or nurse may stop the infusion and administer another counteracting medication through an intravenous line or under the surface of your skin, or you may be asked to take a medication by mouth.
You will be monitored for 1-2 hours after the infusion.
What Results Can You Expect from Infliximab?
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| Infliximab Psoriasis Infusion |
Well-designed clinical studies have evaluated the effects of infliximab in psoriasis and psoriatic arthritis. Infliximab is one of the most effective, if not the most effective, medications in treating psoriasis, with a rapid onset of action. Approximately 80 percent of patients in the 5 milligram/kilogram dosing group had an excellent response to infliximab. In addition, the response to infliximab was very rapid, having a significant effect within four weeks for many patients.
Several distinguishing features of infliximab have become evident from these studies:
- Infliximab patients experience a rapid improvement in psoriasis.
- Improvements are seen as early as two weeks after an infliximab infusion.
- A significant improvement was noted, with more than 80 percent of patients achieving an excellent improvement.