PMID- 12921510
OWN - NLM
STAT- MEDLINE
DCOM- 20031106
LR  - 20151119
IS  - 1060-0280 (Print)
IS  - 1060-0280 (Linking)
VI  - 37
IP  - 9
DP  - 2003 Sep
TI  - Infliximab treatment of rheumatoid arthritis and Crohn's disease.
PG  - 1256-65
AB  - OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, safety, and 
      pharmacoeconomic impact of infliximab in the treatment of Crohn's disease (CD) 
      and rheumatoid arthritis (RA). DATA SOURCES: MEDLINE and Pre-MEDLINE (1966-June 
      2002) and manufacturer prescribing literature were employed to find 
      English-language articles on infliximab. Additional studies and abstracts were 
      identified from the bibliographies of reviewed literature and conference 
      proceedings. STUDY SELECTION/DATA EXTRACTION: All articles identified from data 
      sources were evaluated, and all information deemed relevant was included in this 
      review. Information regarding basic pharmacology was collected from studies in 
      animals. Pharmacokinetic data were collected from human trials. Safety data were 
      extracted from clinical trials and postmarketing surveillance. Priority was given 
      to randomized, double-blind, placebo-controlled studies for the assessment of 
      efficacy. All available economic evaluations were included. DATA SYNTHESIS: 
      Infliximab is a new monoclonal antibody that appears to work by a unique 
      mechanism: inhibiting the action of tumor necrosis factor-alpha (TNF-alpha). 
      Infliximab is administered by intravenous infusion. In clinical trials in CD, 
      infliximab significantly decreased the CD activity index compared with placebo in 
      treatment-resistant disease and significantly reduced the number of draining 
      fistulas in fistulizing disease. In RA, when infliximab was added to methotrexate 
      (MTX), it resulted in a significant improvement in most disease outcome measures 
      when compared with MTX plus placebo. Few major adverse effects were reported in 
      the clinical trials; however, serious adverse events, including malignancy and 
      demyelination, have been reported in postmarketing surveillance. Also, increased 
      susceptibility to infections (including tuberculosis) has been reported. 
      CONCLUSIONS: Infliximab is an effective new agent for the treatment of CD and RA. 
      Its apparent unique mechanism of action makes infliximab an important addition to 
      therapy. Caution should be exercised when considering infliximab for individuals 
      who have chronic or recurrent infections, mild congestive heart failure (New York 
      Heart Association [NYHA] class I/II), nervous system disorders, or live or have 
      lived in an area endemic for histoplasmosis. Infliximab is contraindicated for 
      patients with a clinically important, active infection, moderate to severe 
      congestive heart failure (NYHA class III/IV), or an allergy to mouse proteins or 
      any of the ingredients in infliximab. Further long-term efficacy, safety, and 
      economic data on infliximab are required. Also, for the treatment of RA, the 
      burden of administering infliximab (as a 2-hour supervised infusion) has to be 
      considered when choosing among anti-TNF-alpha medication (as the other 2 approved 
      agents, etanercept and adalimumab, can be self-administered by subcutaneous 
      injection).
FAU - Nahar, Ibrahim K
AU  - Nahar IK
AD  - Division of Rheumatology, Faculty of Medicine, University of British Columbia, 
      Vancouver, British Columbia, Canada.
FAU - Shojania, Kam
AU  - Shojania K
FAU - Marra, Carlo A
AU  - Marra CA
FAU - Alamgir, Abul H
AU  - Alamgir AH
FAU - Anis, Aslam H
AU  - Anis AH
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antirheumatic Agents)
RN  - B72HH48FLU (Infliximab)
SB  - IM
MH  - Antibodies, Monoclonal/economics/pharmacokinetics/*therapeutic use
MH  - Antirheumatic Agents/economics/pharmacokinetics/*therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy
MH  - Clinical Trials as Topic
MH  - Crohn Disease/*drug therapy
MH  - Humans
MH  - Infliximab
MH  - Treatment Outcome
RF  - 50
EDAT- 2003/08/19 05:00
MHDA- 2003/11/07 05:00
CRDT- 2003/08/19 05:00
PHST- 2003/08/19 05:00 [pubmed]
PHST- 2003/11/07 05:00 [medline]
PHST- 2003/08/19 05:00 [entrez]
AID - 10.1345/aph.1C039 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2003 Sep;37(9):1256-65. doi: 10.1345/aph.1C039.