Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Infliximab is an antibody administered
intravenously that is used for treating several chronic inflammatory diseases.
Infliximab works by blocking the effects of tumor necrosis factor alpha (TNF
alpha), a substance made by cells of the body which has an important role in
promoting inflammation. There are two other injectable drugs that block TNF
alpha--adalimumab (Humira) and etanercept (Enbrel). Specifically, infliximab is
used for treating the inflammation of Crohn's disease, rheumatoid arthritis,
psoriasis, ankylosing spondylitis, and psoriatic arthritis. By blocking the
action of TNF-alpha, infliximab reduces the signs and symptoms of inflammation.
Infliximab does not cure Crohn's disease, psoriatic arthritis, or rheumatoid
arthritis. Infliximab can retard the destruction of joints by rheumatoid
arthritis. The FDA approved infliximab in August 1998.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Powder for intravenous injection, 100 mg
STORAGE: Infliximab should be refrigerated at 2-8 C (36-46 F)
PRESCRIBED FOR: Infliximab is approved for use alone or combined with
methotrexate
(Rheumatrex, Trexall) for treating moderate to severe rheumatoid arthritis.
Infliximab is
used for reducing the signs and symptoms of inflammation in moderate to severe
Crohn's disease and Crohn's disease in which there are fistulas (passageways
created when the inflammation penetrates beyond the wall of the intestine).
It
also is approved for the treatment of active psoriatic arthritis. Infliximab is
helpful in reducing the joint inflammation of juvenile rheumatoid arthritis,
ankylosing spondylitis, plaque psoriasis, and psoriatic arthritis.
It also has
been found to be helpful in treating the inflammation of uveitis and sarcoidosis
that is not responding to traditional therapies.
Infliximab is approved for use
in pediatric patients with moderately to severely active Crohn's disease who
have had an inadequate response to conventional therapy.
DOSING: Infliximab is administered intravenously. The recommended dose
is a 5 mg/kg infusion at 0, 2, and 6 weeks and then 5 mg/kg every 8 weeks for
moderate to severe active Crohn's disease or fistulizing Crohn's disease in
adult or pediatric patients. Adults who initially responded then lost response
may be treated with 10 mg/kg.
The recommended dose for the treatment of
moderately to severely active rheumatoid arthritis is 3 mg/kg at 0, 2, and 6
weeks followed by 3 mg/kg every 8 weeks. Infliximab should be combined with
methotrexate. If response is incomplete, up to 10 mg/kg or treating every 4
weeks may be tried.
Ulcerative colitis, psoriatic arthritis, and plaque
psoriasis are treated with a 5 mg/kg infusion at 0, 2, and 6 weeks and then 5
mg/kg every 8 weeks.
Ankylosing spondylitis is treated with a 5 mg/kg infusion
at 0, 2, and 6 weeks then 5 mg/kg every 6 weeks.
DRUG INTERACTIONS: Because infliximab may reduce the response of the
immune system, it should not be administered with vaccines containing live
bacteria or viruses. Combining infliximab with anakinra (Kineret), abatacept (Orencia)
or tocilizumab (Actemra), drugs that also reduce the response of the immune
system, may increase the risk of serious infections.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Kawasaki disease is a rare children's disease characterized by a fever that lasts more than five days and at least four of the following five symptoms are present: rash, swollen neck lymph gland, red tongue, swelling or redness of the hands or feet, and conjunctivitis. High doses of aspirin are used to treat Kawasaki disease. Cortisone and antiinflammatory drugs may also be used during treatment.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal antiinflammatory drugs (NSAIDs), and cortisone medications.
Ankylosing spondylitis is a form of chronic inflammation
of the spine and the sacroiliac joints. The sacroiliac joints
are located in the low back where the sacrum (the bone directly
above the tailbone) meets the iliac bones (bones on either side
of the upper buttocks). Chronic inflammation in these areas causes
pain and stiffness in and around the spine. Over time, chronic
inflammation of the spine (spondylitis) can lead to a complete cementing
together (fusion) of the vertebrae, a process referred to as ankylosis.
Ankylosis leads to loss of mobility of the spine.
Ankylosing spondylitis is also a systemic disease, meaning it can affect other tissues throughout the body. Accordingly, it
can cause inflammation in or injury to other joints away from the spine, as
well as to other organs, such as the eyes, heart, lungs, and kidneys.
Ankylosing spondylitis shares many features with several other
arthritis
conditions, suc...
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