TNF-a is an inflammatory cytokine thought to have a contributory role in producing chronic inflammation in various diseases, including Crohn's disease and rheumatoid arthritis (see Chapter 36). Infliximab (Remicade) is a mouse-human chimeric monoclonal neutralizing antibody to human TNF-a and is considered a biological drug. Specific indications are for the reduction of signs and symptoms in patients with moderately to severely active Crohn's disease who have had an inadequate response to conventional therapies (single infusion) and for reduction of the number of draining enterocuta-neous fistulas in patients with fistulizing Crohn's disease (three-infusion regimen). Responses occur within 2 weeks of an infusion, and significant clinical responses were reported in 50 to 80% of patients in initial trials with infliximab. This antibody is being studied as maintenance therapy for Crohn's disease and to determine the best induction regimen to achieve remission.

The most common side effects, which are related to the intravenous infusion itself, include rash, low blood pressure, chills, and chest pain. These symptoms are generally temporary and often respond to a decrease in infusion rate. In addition, some patients develop antibodies, which have been associated in rare cases with symptoms similar to those of patients with systemic lupus erythematosus. These symptoms were also temporary. Another side effect is increased risk of infections. Fatal cases of tuberculosis have been reported following infliximab therapy. Another potential side effect is an increased risk of lymphoma. Its occurrence remains controversial.

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