From the Guidelines
Oral steroids and Remicade (infliximab) infusions should be used together to treat inflammatory conditions, with oral steroids like prednisone (typically 20-40mg daily) prescribed for 2-4 weeks to quickly control inflammation while waiting for Remicade to take effect, as infliximab may require 2-3 infusions (at weeks 0,2, and 6) before reaching full efficacy 1.
Treatment Approach
When starting Remicade, the standard dosing is 3-5mg/kg per infusion, with maintenance doses every 8 weeks after induction.
- The combination of oral steroids and Remicade works well because steroids broadly suppress immune function while Remicade specifically blocks tumor necrosis factor (TNF), a key inflammatory molecule.
- Patients should be monitored for infections during treatment as both medications suppress immune function, and should receive tuberculosis screening before starting Remicade due to increased risk of TB reactivation.
Steroid Tapering
Once Remicade becomes effective, steroids are usually tapered gradually (reducing by 5mg every 1-2 weeks) to minimize withdrawal symptoms and prevent disease flares.
- This approach is supported by the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults, which recommends combination therapy of infliximab with an immunomodulator to reduce immunogenicity 1.
Patient Monitoring
Patients should be closely monitored for signs of infection, and their disease activity should be regularly assessed to adjust the treatment plan as needed.
- The use of concomitant immunomodulator therapy, such as methotrexate, may reduce immunogenicity and increase trough levels of infliximab, which may be clinically beneficial for longer-term maintenance therapy 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Oral Steroid and Remicade Infusion
- The use of oral steroids and Remicade (infliximab) infusion has been studied in various contexts, including the treatment of sarcoidosis, inflammatory bowel disease, and Behçet disease.
- In the context of sarcoidosis, corticosteroids remain the first-choice therapeutic option, but long-term use is associated with toxicity 2.
- Infliximab has been shown to be effective in reducing inflammation and improving visual acuity in patients with Behçet disease who failed to respond to conventional therapy 3.
- In patients with acute severe ulcerative colitis, an accelerated infliximab induction regimen has been shown to reduce the need for early colectomy 4.
- The pharmacokinetics of infliximab have been studied, and it has been shown to have a half-life of 10-14 days, with no accumulation observed when administered at intervals of 4 or 8 weeks 5.
Treatment Options
- Corticosteroids, such as prednisone, are commonly used as first-line therapy for various inflammatory conditions.
- Infliximab is a biologic agent that has been shown to be effective in treating various conditions, including sarcoidosis, inflammatory bowel disease, and Behçet disease.
- Other treatment options, such as methotrexate, azathioprine, and cyclosporine, may also be used in certain contexts.
Efficacy and Safety
- The efficacy and safety of oral steroids and Remicade infusion have been studied in various clinical trials.
- Infliximab has been shown to be effective in reducing inflammation and improving symptoms in patients with various inflammatory conditions 4, 3.
- However, the use of infliximab has also been associated with certain adverse effects, such as infections and infusion reactions 2, 5.