A new type of treatment for inflammatory bowel disease is now available with the launch of Schering Plough's infliximab (Remicade).
Infliximab is a monoclonal antibody to tumour necrosis factor a (TNFa) and is licensed as a second line treatment for severe, active Crohn's disease and for fistulising Crohn's disease (see p963). The drug, which forms complexes with human TNFa, has immunosuppressant properties.
Schering Plough reports a clinical study in which a clinical response was noted in 81 per cent of patients with moderate-to-severe, active Crohn's disease receiving infliximab, compared with 17 per cent of patients in a placebo group.
In a study in patients with fistulising Crohn's disease, 68 per cent of patients achieved a clinical response, compared with 26 per cent of placebo patients.
Infliximab is also being investigated in rheumatoid arthritis, a disease which, like Crohn's disease, is associated with overproduction of TNFa. A multicentre trial published this week in the Lancet (1999;354:1932) shows infliximab plus methotrexate to be more effective than methotrexate alone in rheumatoid arthritis patients who were inadequately controlled on methotrexate alone.
The authors report a rapid reduction in disease activity measurements in response to infliximab, with significant improvement in over 50 per cent of treated patients.
A UK licence for use in rheumatoid arthritis is expected next year. Infliximab is a Centocor drug, but it is being marketed by Schering Plough