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FDA Approves Infliximab To Treat Ulcerative Colitis
Remicade is now indicated for reducing signs and symptoms, achieving clinical remission and mucosal healing and eliminating corticosteroid use in patients with moderately to severely active UC who have had an inadequate response to conventional therapy. This is an unprecedented milestone in the treatment of moderate-to-severe UC; to date, no therapy has ever been indicated for mucosal healing and eliminating the use of corticosteroids.
"The approval of Remicade for the treatment of UC represents a major breakthrough for patients suffering from this often debilitating disease," said William J. Sandborn, M.D., professor of medicine, Mayo Clinic College of Medicine and head of the IBD Interest Group and director of the IBD Clinical Research Unit at Mayo Medical Center. "Not only did many patients in clinical trials experience a significant reduction in the occurrence of symptom flare-ups with Remicade, some achieved clinical remission and mucosal healing as well. This is welcome news for these patients whose only option otherwise may have been surgery to remove their colons."
The efficacy of Remicade in the treatment of IBD is well established. First approved in the United States for the treatment of Crohn's disease (CD) in 1998, Remicade remains the only anti-tumor necrosis factor (TNF-alpha) therapy indicated for the treatment of CD. With this new approval for the treatment of ulcerative colitis, Remicade is now the only biologic indicated for the treatment of both types of inflammatory bowel diseases, CD and UC.
In addition to UC and CD, Remicade is also indicated for the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. More than 600,000 patients have been treated with Remicade worldwide. This new approval for the treatment of UC continues to demonstrate the benefit of Remicade across immune-mediated inflammatory diseases.
UC is a debilitating chronic disease affecting more than 500,000 Americans, for whom there is no medical cure, and while UC affects more people in the United States than multiple sclerosis or cystic fibrosis, general awareness of the disease is lower. Characterized by inflammation and ulceration of the inner lining of the colon, UC symptoms can often include unwanted weight loss, severe – sometimes uncontrollable – bloody diarrhea, fatigue and frequent abdominal pain. For some patients, symptoms may lead to surgical removal of the colon or to secondary complications such as colorectal cancer.
"We are optimistic that the use of a treatment like REMICADE® will provide many people with relief from the debilitating symptoms that have had such a profound impact on their lives," said Rodger DeRose, president and CEO of the Crohn's & Colitis Foundation of America. "Results from a recent patient survey revealed that UC affects many aspects of people's lives, from their relationships with families and employers to the ability to participate in social activities."
Clinical Trial Information: ACT 1 and ACT 2
The approval of Remicade is based on positive results seen in two randomized, placebo-controlled pivotal Phase 3 clinical trials, ACT 1 and ACT 2, which were conducted to evaluate the safety and efficacy of Remicade in people with active, moderate-to-severe UC.
In each trial, 364 patients with active UC who were unresponsive to at least one standard therapy – including corticosteroids, immunosuppressants or 5-ASAs – were enrolled. Patients in ACT 1 and ACT 2 had evidence of moderate or severe UC (total Mayo score of six to 12 and an endoscopy score greater than or equal to two). In both trials, patients were randomized to receive placebo or Remicade 5 mg/kg or 10 mg/kg. ACT 1 patients received the study agent at weeks zero, two and six and then every eight weeks through week 46 and had their last evaluations at week 54. ACT 2 patients received the study agent at weeks zero, two and six and then every eight weeks through week 22 and had their last evaluations at week 30.
In ACT 1, significantly higher proportions of patients receiving Remicade 5 mg/kg (69 percent) and 10 mg/kg (62 percent) achieved clinical response at week eight versus placebo-treated patients (37 percent; P At week eight, 39 percent and 32 percent of patients treated with Remicade 5 mg/kg and 10 mg/kg, respectively, were in clinical remission compared to 15 percent of placebo-treated patients (P In ACT 2, significantly higher proportions of patients receiving REMICADE® 5 mg/kg (65 percent) and 10 mg/kg (69 percent) were in clinical response at week eight versus 29 percent who received placebo (P Clinical remission was achieved at week eight in 34 percent and 28 percent of Remicade and 10 mg/kg patients, respectively, compared to six percent of placebo-treated patients (P The serious adverse events reported in these trials were similar to those reported in previous Remicade clinical trials. (See Important Safety Information below).
Remicade is the global market leader among anti-tumor necrosis factor alpha (TNF-alpha) therapies and the only agent approved for the treatment of both rheumatoid arthritis (RA) and CD in North America, the EU and Japan. In the U.S., Remicade, in combination with methotrexate, is indicated for reducing signs and symptoms, inhibiting the progression of structural damage and improving physical function in patients with moderately to severely active RA. Remicade is the only biologic indicated for the treatment of patients with moderately-to-severely active CD who have had an inadequate response to conventional therapy. REMICADE® is also indicated for reducing the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure in patients with fistulizing CD. In December 2004, Remicade was approved for the treatment of active ankylosing spondylitis in the U.S. On May 13, 2005, REMICADE® was approved for the treatment of psoriatic arthritis.
Remicade is unique among available anti-TNF biologic therapies. Unlike self-administered therapies that require patients to inject themselves frequently, Remicade is the only anti-TNF biologic administered directly by caregivers in the clinic or office setting. In RA and CD, Remicade is a two-hour infusion administered every eight weeks, following a standard induction regimen that requires treatment at weeks zero, two and six. As a result, Remicade patients may require as few as six treatments each year. In ankylosing spondylitis, Remicade is a two-hour infusion (5 mg/kg) administered every six weeks, following a standard induction regimen that requires treatment at weeks zero, two and six. The safety and efficacy of REMICADE® have been well established in clinical trials over the past 12 years and through commercial experience with over a half-million patients treated worldwide.
Important Safety Information
Many people with heart failure should not take Remicade so prior to treatment you should discuss any heart condition with your doctor. Tell your doctor right away if you develop new or worsening symptoms of heart failure (such as shortness of breath or swelling of your ankles or feet). There are reports of serious infections, including tuberculosis (TB), sepsis and pneumonia. Some of these infections have been fatal. Tell your doctor if you have had recent or past exposure to people with TB. Your doctor will evaluate you for TB and perform a skin test. If you have latent (inactive) TB, your doctor should begin TB treatment before you start REMICADE®. REMICADE® can lower your ability to fight infections, so if you are prone to or have a history of infections, or develop any signs of an infection such as fever, fatigue, cough or the flu while taking REMICADE®, tell your doctor right away. Also tell your doctor if you have lived in a region where histoplasmosis or coccidioidomycosis is common.
There have been rare cases of serious liver injury in people taking REMICADE®, some fatal. Contact your doctor immediately if you develop symptoms such as jaundice (yellow skin and eyes), dark brown urine, right-sided abdominal pain, fever or severe fatigue.
Blood disorders have been reported, some fatal. Tell your doctor if you develop possible signs of blood disorders such as persistent fever, bruising, bleeding or paleness while taking REMICADE®. Nervous system disorders have also been reported. Tell your doctor if you have or have had a disease that affects the nervous system, or if you experience any numbness, weakness, tingling or visual disturbances while taking REMICADE®.
Reports of a type of blood cancer called lymphoma in patients on REMICADE® or other TNF blockers are rare but occur more often than expected for people in general. People who have been treated for rheumatoid arthritis, Crohn's disease, ankylosing spondylitis or psoriatic arthritis for a long time, particularly those with highly active disease, may be more prone to develop lymphoma. Cancers, other than lymphoma, have also been reported. If you take Remicade or other TNF blockers, your risk for developing lymphoma or other cancers may increase. You should also tell your doctor if you have had or develop lymphoma or other cancers while you are taking Remicade.
Serious infusion reactions have been reported with REMICADE®, including hives, difficulty breathing and low blood pressure. Reactions have occurred during or after infusions. In clinical studies, some people experienced the following common side effects: respiratory infections (that may include sinus infections and sore throat), coughing and stomach pain or mild reactions to infusion such as rash or itchy skin.
Please read important information about REMICADE®, including full prescribing information at www.remicade.com.