Remicade (infliximab)

Reviewed by: HU Medical Review Board | Last Reviewed: April 2022 | Last updated: October 2022

Infliximab is a type of medication that can be used to treat people who have moderately or severely active inflammatory bowel disease (IBD), including Crohn’s disease (CD) or ulcerative colitis (UC).1,2 It can also be used to treat people who have fistulizing CD. Infliximab is a type of medication called a biologic therapy, and it is sold in the United States under the brand name Remicade.

How does infliximab work?

Infliximab is a type of biologic therapy called an anti-tumor necrosis factor (anti-TNF) medicine.1,2,3 The active ingredients in anti-TNF medicines are special proteins called antibodies. These antibodies work by specifically targeting and interfering with the function of another kind of protein made by the immune system, called “tumor necrosis factor alpha.” These proteins are responsible for triggering inflammation to fight off infections in the body.

People with certain diseases, such as IBD, may have too much of this protein. Having too much of the protein can cause the immune system to attack parts of the body that are healthy. For people with IBD, these proteins can trigger the excessive inflammation in the digestive tract that causes IBD symptoms, as well as damaging the lining of the intestine. The antibodies in infliximab work by blocking the protein’s ability to cause this inflammation.

During the studies that were carried out to test the effectiveness of infliximab in treating IBD, more than 50% of patients had improvements in their symptoms after 2 weeks, although for other people it can take up to 8 weeks to start working.

How is infliximab used to treat inflammatory bowel disease?

For patients with moderate or severe CD or UC, infliximab’s ability to block these inflammation-causing proteins can:1-4

  • Reduce the symptoms of IBD
  • Help them to enter remission
  • Help them to stay in remission longer

Infliximab can also help to heal the inside lining of the intestine, which can become damaged by inflammation due to IBD. New research suggests that because of this healing effect, people who have taken infliximab for a year tend to have fewer hospitalizations and a reduced need for surgery.

For adult patients who have fistulizing CD, taking infliximab can also help to:

  • Reduce the number of draining fistulas between the digestive tract and the skin (enterocutaneous fistula) or between the rectum and the vagina (rectovaginal fistula)
  • Maintain fistula closures

Infliximab can also be used to treat people with IBD who have symptoms that are located outside of the digestive tract, including:

  • Ankylosing spondylitis
  • Pyoderma gangrenosum
  • Uveitis
  • Metastatic CD

For some people, infliximab does not work well enough to control their symptoms, or it may work at the beginning and then eventually stop working. In those cases, healthcare providers may recommend that they try another kind of biologic medicine, such as adalimumab.

Who can take infliximab?

Infliximab is approved for treating adults and children (over six years of age) with moderate to severe CD that has not responded well enough to other types of therapies, such as aminosalicylates, antibiotics, corticosteroids, or immunosuppressants. Infliximab is approved for treating adults with fistulizing CD. Infliximab is also approved to treat ulcerative colitis, in those 6 and over who have moderate to severe disease and who have not had a response to other therapies.3

Women who are pregnant, planning to become pregnant, or breastfeeding should let their healthcare providers know before starting treatment with infliximab. Anyone who is taking the medication should not receive any kind of live vaccine. Patients will be tested for TB before starting treatment.3

Before prescribing infliximab, healthcare providers need to know if the patient has, or has ever had:3

  • Tuberculosis, or has been near someone with tuberculosis
  • Recurring infections
  • Diabetes
  • Immune system problems
  • Any type of cancer
  • Chronic obstructive pulmonary disease (COPD)
  • Heart failure or other heart condition
  • Hepatitis B
  • Nervous system conditions, such as multiple sclerosis or Guillain-Barre syndrome

What side effects can taking infliximab cause?

The most common side effects experienced by people taking infliximab are respiratory infections, headache, rash, coughing, and stomach pain.3

Because of the way it affects the immune system, taking infliximab can reduce the body’s ability to fight off infections, including dangerous infections such as tuberculosis, pneumonia, and blood infections. For this reason, health care providers test patients for tuberculosis prior to starting treatment, and continue to monitor the patient throughout the treatment for signs of any infections.3

Taking infliximab can cause some very serious side effects. These are not all the possible side effects of infliximab. Patients should talk to their doctor about what to expect with treatment with infliximab. Healthcare providers will carefully monitor patients for signs or symptoms of the following conditions:3

  • Lymphoma
  • Hepatosplenic T-Cell Lymphoma (HSTCL)
  • Skin cancer
  • Heart failure
  • Hepatitis B
  • Liver injury
  • Blood disorders
  • Nervous system disorders
  • Psoriasis

To note: lymphoma and HSTCL are black box warnings.

Patients should seek medical help immediately if they experience any signs of an allergic reaction during or after the infusion:3

  • Hives
  • Trouble breathing
  • Chest pain
  • High or low blood pressure
  • Swelling of the face and/or hands
  • Fever or chills

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