Remicade is one of the most effective medications to treat severe forms of arthritis to come along in fifty years. It's a biologic agent, meaning a drug made from gene engineering rather than from chemicals. We give Remicade to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other forms of severe inflammation such as psoriasis and Crohn’s disease (see below.)
Remicade is the most potent of a group of medications called TNF inhibitors. TNF stands for tumor necrosis factor, a chemical that attacks cancers and most importantly for arthritis patients, makes the joints inflamed.
Remicade acts like a sponge to remove TNF from the bloodstream and the joints. Without this chemical to cause inflammation, the joints return to normal. The medication is given intravenously, every two months or so. The schedule is flexible, so that patients who begin to feel pain again at six weeks, for example, may get their IV infusion of Remicade every six week instead of every eight.
This flexibility is what sets Remicade apart from the other two anti-TNF drugs approved by the FDA, Enbrel and Humira. Each of these drugs must be used on a fixed dosage schedule: patients must take Enbrel twice a week by self-administered injection or Humira every two weeks by self-injection. If patients do not improve on these two drugs, increasing the dosage is not effective, and treatment failures result.
Remicade is different. Because it is given intravenously, we can increase the dose in increments until a patient feels better. As mentioned above, we can also change the interval between infusions, to match the medication to the patient’s need.
It is our experience that patients who take Enbrel or Humira may miss their shots, as they are sometimes lax in taking a drug that they have to administer to themselves. Because we give the Remicade in our own infusion suite, we can make sure that each patient gets the medication on time and in the exact amount prescribed. We can monitor the infusion and can be present to handle any problems that may arise.
We use the medication to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, seronegative arthritis / spondyloarthropathy and other forms of severe inflammation. We have received referrals from other rheumatologists for Remicade infusions when those doctors have treatment failures with Enbrel and Humira, but have no infusion facilities or are not experienced in the use of Remicade. Several gastroenterologists refer us Crohn’s disease patients for their Remicade infusions and dermatologists have referred patients with severe psoriasis and eczema for Remicade.
The TNF inhibitors work the best when they are given with methotrexate, a powerful anti-arthritis medication in itself. Because of the power of Remicade, however, we can use the lowest doses of methotrexate and still insure a patient's improvement.
We have a complete infusion facility at the Center with Remicade-trained Registered Nurses and a physician at all times to check infusion progress and to look for problems. We have a Wi-Fi router in the suite so that patients may use wireless devices while they get the intravenous medication; there are also four portable DVD players to view movies. Infusions take about an hour and a half to two hours, and most patients appreciate some diversion during that time. With our four La-Z-Boy recliners, patients may read or sleep through the procedure.
We have about 200 patients at the Center who get Remicade, and have been using it here since it was approved by the FDA almost five years ago. Each year, we give approximately 1200 infusions of Remicade. Our experience with the medication and the number of infusions we have given makes us the most knowledgeable private facility for Remicade use in the New York Metropolitan area.
The Center and one of our Remicade patients were featured in the New York Daily News.
© Jay Adlersberg 2010
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