What is your take on Remicade, the drug for Crohn's disease? I've been experiencing a lot of problems with my Crohn's and am wondering if maybe this drug would help my flare-ups.

S.H.

Crohn's disease (CD) is a chronic inflammatory disorder that can affect your entire digestive tract. However, it most commonly occurs in the last part of the small intestine (ileum). CD causes inflammation and open sores (ulcers) that may result in diarrhea, bloody stools, abdominal pain and weight loss.

Traditionally, medications with anti-inflammatory properties have been prescribed to reduce CD symptoms and all have been effective to varying degrees. Unfortunately, they have not provided sufficient symptom relief for all Crohn's patients.

Infliximab (brand name Remicade) is a relatively new medication that blocks a particular molecule that is elevated in patients with active Crohn's disease. This molecule, called tumor necrosis factor (TNF), aids in the body's immune response. Increased TNF levels result in inflammation, pain and damage to body tissues.

Medications that block TNF may help reduce inflammation and assist in healing. Infliximab was approved by the U.S. Food and Drug Administration in 1998 to treat children (over age 6) and adults with CD who do not respond well to traditional therapies. Remicade is administered through an I.V. over the course of about two hours. Follow-up infusions may occur over a period of weeks or months.

The results of Remicade studies have been encouraging thus far in patients with moderate-to-severe CD who had not responded to other therapies. An early study showed that more than two-thirds of patients had specific symptoms reduced by half and some experienced complete remission. Long-term follow-up studies are ongoing.

Some individuals are poor candidates for Remicade use because of other medical conditions and especially if they take certain medications that suppress the immune system. Another drug called adalimumab (brand name Humira) may be more effective for some new CD patients. Researchers continue to investigate cells involved in inflammation and are working on other medications to target them.

Sources: Crohn's Disease, iVillage Total Health
National Institute of Diabetes and Digestive and Kidney Diseases
Mayo Clinic
American Journal of Gastroenterology, January 2005
New England Journal of Medicine, May 6, 1999