INFLIXIMAB - A REVIEW OF ITS USE IN CROHNS-DISEASE AND RHEUMATOID-ARTHRITIS

Infliximab is a chimaeric monoclonal antibody which binds to and inhib its the activity of tumour necrosis factor-alpha (TNF alpha), a cytoki ne which is involved in the development of both Crohn's disease and rh eumatoid arthritis. In patients with treatment-resistant Crohn's disea se, infliximab was significantly more effective than placebo in the re lief of symptoms. 50 to 89% of patients responded to infliximab and mo st of them also achieved remission. Patients showed signs of relapse 8 to 12 weeks after a single infusion but responded to additional infus ions of the drug. Infliximab was also effective in closing the fistula e in 68% of patients with fistulising Crohn's disease; the response ra te with placebo was 26%. Infliximab achieved a clinical response in 44 to 81% of patients with refractory rheumatoid arthritis. Following a single infusion, symptom recurrence was evident after 6 to 12 weeks, b ut subsequent infusions re-established a clinical response. Concurrent methotrexate appeared to prolong the effects of infliximab in this pa tient group. Anti-infliximab and anti-double-stranded DNA antibodies d eveloped in some patients, particularly those who received multiple in fusions of infliximab. Acute adverse events consistent with hypersensi tivity occurred in some patients who received multiple infusions of in fliximab. Infection occurred slightly more frequently with infliximab than with placebo. Conclusions: Infliximab appears to be an effective therapy for patients with treatment-resistant or fistulising Crohn's d isease or refractory rheumatoid arthritis. The tolerability, long term efficacy and optimal dosage regimen need to be further defined in com parative trials before the full potential of infliximab is realised in these patients.