How much does a Remicade infusion cost with and without insurance. What factors influence the price of Remicade treatments. How can patients reduce their out-of-pocket expenses for Remicade infusions. Where is the most cost-effective location to receive Remicade treatments.

Understanding Remicade: Purpose and Mechanism of Action

Remicade, also known by its generic name infliximab, is a monoclonal biologic antibody used to treat various autoimmune diseases. But what exactly does it do? Remicade works by targeting and inhibiting tumor necrosis factor-alpha (TNF-alpha), a protein produced by the immune system that can cause inflammation and damage to healthy tissues when present in excessive amounts.

This medication is prescribed for conditions such as:

• Crohn’s disease
• Ulcerative colitis
• Rheumatoid arthritis (often in combination with methotrexate)
• Ankylosing spondylitis
• Psoriatic arthritis
• Plaque psoriasis

By suppressing the action of TNF-alpha, Remicade helps to reduce inflammation and alleviate symptoms associated with these autoimmune disorders. This targeted approach makes it an effective treatment option for many patients who have not responded well to other therapies.

The Cost of Remicade Infusions: Breaking Down the Numbers

One of the most pressing questions for patients prescribed Remicade is: How much does a Remicade infusion cost? The answer can be quite sobering. Remicade infusions typically range from $3,000 to $12,000 per treatment. Over the course of a year, this can add up to a staggering $50,000 to $150,000.

Why is Remicade so expensive? There are several factors contributing to its high cost:

1. Complex manufacturing process: As a biologic medication, Remicade is more difficult and expensive to produce than traditional small-molecule drugs.
2. Research and development costs: The extensive clinical trials and studies required to bring Remicade to market contribute to its price.
3. Ongoing treatment: Many patients require regular infusions over long periods, which increases the overall cost of therapy.
4. Limited competition: While biosimilars are becoming available, the market for Remicade alternatives is still relatively small, allowing for higher pricing.

Insurance Coverage and Its Impact on Remicade Costs

For most patients, insurance coverage plays a crucial role in determining the out-of-pocket costs for Remicade infusions. How does insurance affect the price of Remicade treatments? The answer depends on the specific insurance plan and its terms. Here are some key concepts to understand:

• Copay: A fixed amount paid by the patient for each healthcare service, typically ranging from $0 to $50 per visit.
• Coinsurance: A percentage of the total cost of treatment that the patient is responsible for paying.
• Deductible: The amount a patient must pay out-of-pocket before their insurance begins to cover costs.

Due to the high cost of Remicade infusions, many patients will meet their deductible with their first treatment of the year. This means that subsequent infusions may have lower out-of-pocket costs, as the insurance plan will cover a larger portion of the expenses.

What if You Don’t Have Insurance or Remicade Isn’t Covered?

If you lack insurance coverage or your provider doesn’t include Remicade in its formulary, there are still options to explore. Some possibilities include:

• Billing your insurance for out-of-network benefits
• Seeking treatment as a self-pay patient
• Investigating manufacturer assistance programs
• Discussing alternative medications with your healthcare provider

The Impact of Treatment Location on Remicade Infusion Costs

Where you receive your Remicade infusion can significantly impact the overall cost. What are the options for Remicade infusion locations, and how do they compare in terms of price?

1. Hospital outpatient departments: This is where 50-60% of infusions take place nationally. However, it’s generally the most expensive option, often costing about twice as much as other settings.
2. Home infusion: While convenient, home infusion services tend to be about 50% more expensive than receiving treatment in a healthcare provider’s office.
3. Office settings (Ambulatory Infusion Centers or Specialty Doctor’s Offices): These locations typically offer the most affordable care for patients who have been referred for infusion therapy.

When choosing a location for your Remicade infusions, it’s essential to consider both cost and convenience. Discuss the options with your healthcare provider to determine the best choice for your specific situation.

Strategies to Lower Remicade Infusion Costs

Given the high cost of Remicade treatments, many patients seek ways to reduce their financial burden. What strategies can help lower the cost of Remicade infusions?

• Manufacturer assistance programs: Janssen, the maker of Remicade, offers the Janssen Carepath Savings Program. This program can cover up to $20,000 per year for eligible patients, significantly reducing out-of-pocket expenses.
• Patient assistance programs: These programs, often offered by pharmaceutical companies or non-profit organizations, can help patients who meet certain income criteria access medications at reduced or no cost.
• Biosimilar alternatives: Discuss with your doctor whether a lower-cost biosimilar medication, such as Inflectra, might be appropriate for your condition.
• Negotiate with providers: Some healthcare providers may be willing to offer discounts for self-pay patients or those facing financial hardship.
• Explore clinical trials: Participating in clinical trials for Remicade or similar medications may provide access to treatment at reduced or no cost.

Remicade Without Insurance: Understanding Your Options

For patients without insurance coverage, the prospect of paying for Remicade infusions out-of-pocket can be daunting. How can uninsured patients access Remicade treatments? While challenging, there are several avenues to explore:

1. Manufacturer assistance programs: As mentioned earlier, Janssen’s Carepath Savings Program can provide significant financial support, even for uninsured patients.
2. Patient assistance programs: These programs often cater to uninsured or underinsured individuals who meet specific income criteria.
3. Community health centers: Some federally qualified health centers may offer Remicade infusions at reduced costs based on a sliding scale.
4. Medical tourism: While not ideal for everyone, some patients explore receiving treatment in countries where Remicade is available at lower costs.
5. Crowdfunding: Some patients have successfully used crowdfunding platforms to raise money for their medical treatments.

It’s important to note that while these options can help make Remicade more accessible, they may not be suitable or available for everyone. Always consult with healthcare professionals to ensure you’re making the best decision for your health and financial situation.

Comparing Remicade to Alternative Treatments

Given the high cost of Remicade, some patients and healthcare providers may consider alternative treatments. How does Remicade compare to other options in terms of efficacy and cost?

• Biosimilars: Medications like Inflectra and Renflexis are biosimilar to Remicade and may be available at lower costs. They have shown similar efficacy in clinical trials.
• Other TNF inhibitors: Drugs like adalimumab (Humira) or etanercept (Enbrel) work similarly to Remicade but are administered differently, which may affect overall costs.
• Non-TNF biologics: For some conditions, medications targeting other inflammatory pathways may be effective alternatives.
• Conventional DMARDs: For certain autoimmune conditions, traditional disease-modifying antirheumatic drugs (DMARDs) like methotrexate may be considered as less expensive options.

When considering alternatives to Remicade, it’s crucial to weigh both the potential cost savings and the impact on your health. Your healthcare provider can help you understand the pros and cons of each option based on your specific condition and circumstances.

The Future of Remicade Pricing and Accessibility

As the healthcare landscape continues to evolve, what can patients expect regarding the future pricing and accessibility of Remicade? Several factors may influence the cost and availability of this medication in the coming years:

1. Increased competition: As more biosimilars enter the market, there may be downward pressure on Remicade pricing.
2. Patent expirations: When key patents expire, it could pave the way for more generic alternatives, potentially reducing costs.
3. Policy changes: Healthcare reforms and changes in drug pricing policies could impact the cost of specialty medications like Remicade.
4. Advances in treatment: New therapies for autoimmune conditions may emerge, offering alternatives to Remicade.
5. Value-based pricing: There’s a growing trend towards pricing medications based on their demonstrated effectiveness, which could affect Remicade’s cost structure.

While it’s difficult to predict exactly how these factors will play out, patients and healthcare providers should stay informed about developments in the field of autoimmune disease treatment and drug pricing policies.

The Role of Patient Advocacy in Improving Access to Remicade

Patient advocacy groups play a crucial role in improving access to expensive medications like Remicade. How can patients get involved in advocacy efforts? Here are some ways:

• Join patient support groups for your specific condition
• Participate in awareness campaigns about the importance of access to biologic therapies
• Share your story with lawmakers and policymakers
• Support organizations working to improve drug pricing transparency and affordability
• Stay informed about policy changes that could affect access to Remicade and similar medications

By becoming active in patient advocacy, individuals can contribute to broader efforts to make treatments like Remicade more accessible and affordable for all who need them.

Navigating the Complex World of Remicade Infusion Costs

Understanding the costs associated with Remicade infusions can be overwhelming, but it’s an essential part of managing your healthcare. What key points should patients remember when navigating Remicade infusion costs?

• Always review your insurance coverage carefully and understand your out-of-pocket responsibilities
• Explore all available assistance programs, including those offered by the manufacturer
• Consider the impact of treatment location on overall costs
• Discuss potential alternatives with your healthcare provider if costs become prohibitive
• Stay informed about changes in healthcare policies that may affect drug pricing
• Don’t hesitate to ask questions or seek help from patient advocacy groups

By staying informed and proactive, patients can better manage the financial aspects of their Remicade treatment while focusing on their health and well-being.

The Importance of Open Communication with Healthcare Providers

When it comes to managing the costs of Remicade infusions, open communication with your healthcare team is crucial. How can patients effectively discuss cost concerns with their providers? Consider these approaches:

1. Be upfront about your financial situation and any concerns you have about affording treatment
2. Ask about all available options, including alternative medications or treatment schedules that might be more cost-effective
3. Inquire about any ongoing clinical trials or research studies you might be eligible for
4. Request information about financial assistance programs or social services that might be able to help
5. Discuss the possibility of negotiating costs if you’re paying out-of-pocket

Remember, your healthcare team is there to help you achieve the best possible health outcomes. This includes finding ways to make your treatment financially sustainable.

How Much Does Remicade Infusion Cost?

Find out how much Remicade infusions cost (with & without insurance) and how patients can lower costs.

Remicade is the brand name for a monoclonal biologic antibody (infliximab) used to treat several autoimmune diseases, including Crohn’s disease, ulcerative colitis, rheumatoid arthritis (in combination with methotrexate), Ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.

It works by inhibiting the action of a protein produced by the immune system known as tumor necrosis factor-alpha (TNF-alpha), which causes the immune system to attack healthy parts of the body. Those suffering from certain diseases may have too much TNF-alpha.

As with any FDA-approved IV treatment, Remicade can be expensive for a few reasons. First and foremost, it’s a prescription medication that’s expensive to produce. But most eligible patients also need regular infusions over long periods of time, which can contribute to higher costs.

Below, we break down how much Remicade infusions cost (with and without insurance), along with how patients can lower the cost of their infusions.

How much does Remicade cost?

The cost of Remicade can range between $3k-$12k per treatment, totaling upwards of $50k-150k per year.

How does insurance coverage impact the cost of Remicade?

How much the patient pays (aka out-of-pocket costs) is ultimately a function of the insurance plan. Every plan is different, but there are a few concepts that are important to remember:

• Copay: a fixed amount of money that you pay for a healthcare service, which generally totals $0-$50 per visit
• Coinsurance: a percentage of the total cost of a healthcare service
• Deductible: an amount of money you must pay before your health insurance plan starts to share costs
• Or a combination of these options

Because of the high cost of Remicade infusion therapy, a patient will generally meet their deductible in the first infusion of the year, thus he/she would have limited out-of-pocket expenses for treatment costs the rest of the calendar year.

Don’t have insurance or aren’t in-network with your infusion center? It may be possible to bill your insurance company for the medication costs out-of-network. If out-of-network benefits aren’t available, you may be able to be seen as a Self Pay patient.

READ MORE: Prior Authorization: What It Is & How Long It Takes 

How does site of care impact the cost of Remicade?

The only decision a patient can make to influence the cost of their infusion is to decide where to receive treatment. Generally, there are three options where a patient may receive prescription drug infusion therapy from a healthcare professional:

1. Hospital outpatient
2. Home
3. Office setting (Ambulatory Infusion Center or Specialty Doctor’s Office)

Hospital outpatient is where 50-60% of infusions take place nationally. The cost is generally ~2x what it costs in the home or office. Home infusion has received a lot of press recently, but according to the National Infusion Center Association, it tends to be 50% more expensive than a healthcare provider’s office. The office setting will be the most affordable care setting for patients who have received a referral from their physician for infusion therapy.

READ MORE: How Much Does Infusion Therapy Cost?

How can I lower the cost of Remicade infusions?

Manufacturers have copay assistance and financial assistance programs to help offset the cost to patients, such as the Janssen Carepath Savings Program. Based on eligibility requirements, these programs may cover up to $20,000 per year per patient and significantly reduce, or remove, any financial burden a patient may face for the drug’s administration.

Interested in learning more about Remicade IV infusion (including side effects/allergic reactions, FAQs, enrollment qualifications, and more)? Here’s a full guide on what to expect, how long it takes to work, and a run-down of the differences between Remicade and its similar biologic drug/TNF blocker, Inflectra.

How much is Remicade without insurance?

Remicade can be costly without insurance. Learn how to get Remicade at a lower price, or find cheaper alternatives.

Is Remicade covered by insurance? | How much does Remicade cost without insurance? | How to get Remicade without insurance

Remicade is a brand-name drug prescription medication used to treat various autoimmune conditions, which are caused by the immune system attacking healthy tissues in the body. It is approved to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, Crohn’s disease, and ulcerative colitis. Remicade can be an expensive specialty drug because the process to manufacture it is more complex than that of other drugs. It is generally administered as an intravenous (IV) infusion in a doctor’s office, outpatient clinic, or hospital. Medicare and insurance companies may help cover the cost of Remicade, but the exact cost can vary.

Continue reading to learn more about Remicade and how to save on Remicade without insurance.

What is Remicade?

The active ingredient in Remicade is infliximab, a monoclonal antibody. It works by blocking the action of a protein involved with inflammation called tumor necrosis factor-alpha (TNF-alpha). Remicade, like other TNF blockers, can help reduce symptom flare-ups and increase the amount of time between flare-ups. 

Remicade is administered as an IV infusion over a period of two hours. Remicade infusions are usually given every eight weeks by a healthcare professional at an infusion center, outpatient clinic, doctor’s office, or at home. The usual dose of Remicade is  5 mg per kilogram of body weight, although the actual dose can vary depending on the condition being treated. 

Remicade can be expensive as a brand-name drug with no generic versions available. Without health insurance, there are ways to make treatment affordable.

Is Remicade covered by insurance?

Remicade may be covered under some commercial insurance plans. If Remicade is covered, an insurance company may first require prior authorization, a letter of medical necessity or exception, and appeals before approving the prescription.

Health insurance can certainly help make Remicade treatment affordable, but the out-of-pocket costs could still be high. What a patient ends up paying will depend on the formulary, copay cost, deductible, and coinsurance amounts outlined in the health insurance plan’s policy. Some eligible patients with commercial insurance can apply for the Janssen CarePath Savings Program to reduce their out-of-pocket costs.

Remicade may be covered by Medicare Part B and Medicare Advantage plans. However, people on Medicare may find one or more infusions may be more costly because of a coverage gap. Medicaid may also help cover Remicade, depending on the state’s Medicaid clinical policy. 

How much does Remicade cost without insurance?

Remicade could cost around $4,000 to $7,000 or more per dose. That can add up to about $46,000 if Remicade is given every eight weeks for a year. However, the actual price can vary depending on the healthcare provider administering the infusion, location, and other factors. The Remicade dose is based on weight, so people with a higher body weight may pay more per dose than others. 

If Remicade is too expensive or coverage is denied, a healthcare professional may be able to prescribe a less expensive alternative. An FDA-approved biosimilar drug called Inflectra (infliximab-dyyb) is nearly identical to Remicade. Inflectra is just as effective and safe as Remicade, but it is about 40% cheaper than Remicade. 

Other drugs have similar effects as Remicade on the immune system to control or reduce symptoms of autoimmune diseases. The alternatives fall under a group of drugs called biologic disease-modifying antirheumatic drugs (DMARDs), which includes TNF blockers like Remicade. Biologic DMARDs include Cimzia (certolizumab pegol), Humira (adalimumab), and Enbrel (etanercept).

Unfortunately, alternatives to Remicade can be expensive brand-name drugs. People without insurance coverage may need to take more affordable nonbiologic DMARDs, such as corticosteroids, Trexall (methotrexate), Sandimmune (cyclosporine), Arava (leflunomide), Azulfidine (sulfasalazine), or Azasan (azathioprine), for autoimmune disease flare-ups.  

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs. The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see updated drug prices.

How to get Remicade without insurance

Remicade can cost $7,000 for one dose, plus other miscellaneous costs for the infusion. People without insurance can turn to the Johnson & Johnson Patient Assistance Foundation, although there may be eligibility requirements that not everyone can meet. Rest assured, there are ways to reduce the cost of Remicade as long as you’re willing to try more than one strategy. Here are some ways to save.

1. Ask the prescriber about traditional DMARDs

If none of these strategies work, consider switching to more affordable traditional DMARDs. There may be trade-offs, so ask the prescribing healthcare provider for medical advice about your alternatives.

2. Use a SingleCare discount card

A free coupon from SingleCare may reduce the cost of Remicade by over $5,000 if Remicade is purchased from a specialty pharmacy for home use. However, Remicade is rarely purchased directly from pharmacies by patients since it is administered as an IV infusion. 

3. Get a health insurance policy

A year’s worth of Remicade treatment could easily top $46,000 or more, and that doesn’t include the additional fees for the infusion and any tests needed before starting treatment. At such a high price, health insurance is probably one of the best ways to save money. Make sure to consult an agent when evaluating health insurance plans and check the plans’ policies regarding specialty drugs like Remicade.

4. Enroll in Medicaid

For some people, private health insurance is unaffordable. For people who can’t afford private health insurance, Medicaid is a possible option for getting Remicade. However, some state Medicaid plans may not cover Remicade. Start by visiting your state’s Medicaid website for enrollment and eligibility requirements, as well as your state’s Medicaid formulary information. Talk to someone in your state’s Medicaid office to see if Remicade infusions are covered.

5. Consider all the costs

Medication costs are only a fraction of the overall cost of Remicade. In addition to the cost of infusions, office visits and tests can add hundreds or thousands of dollars to the overall cost of treatment. Other potential costs may need to be taken into account; for example, a serious allergic reaction during an infusion may cost thousands of dollars in emergency medical treatment. Ask your healthcare provider for an assessment of all the benefits, costs, and risks involved with different treatment options to find the best treatment for you.

Remicade, search in Chelyabinsk pharmacies

Composition and form of release

Lyophilisate for solution for infusion

1 vial. contains infliximab 100 mg

Pharmacological action

Remicade is an immunosuppressive agent with a high affinity for TNF-alpha, which is a cytokine with a wide biological effect; is a mediator of the inflammatory response and is involved in the modulation of the immune system. TNF-alpha plays a role in the development of autoimmune and inflammatory diseases. The drug quickly binds and forms a stable compound with soluble and transmembrane forms of human TNF-alpha, thereby reducing the functional activity of the latter. The specificity of infliximab for TNF-alpha was confirmed by its inability to neutralize the cytotoxic effect of a lymphotoxin-cytokine using the same receptors as TNF-alpha.

Indications

Rheumatoid arthritis (with the ineffectiveness of previous therapy, including methotrexate). Crohn’s disease (severe course, including with the formation of fistulas; with the ineffectiveness of standard therapy, including corticosteroids and / or immunosuppressants).

Contraindications

Hypersensitivity (including to mouse proteins), abscess, sepsis, tuberculosis, severe infections.

Caution. Pregnancy, lactation, age up to 17 years.

Method of administration and doses

Remicade is administered intravenously over 2 hours at a rate of not more than 2 ml/min, using an infusion system with a built-in sterile pyrogen-free filter with low protein-binding activity. In rheumatoid arthritis, treatment is carried out in combination with methotrexate. The initial single dose of infliximab is 3 mg/kg; after 2 and 6 weeks, they are administered again at the same dose, then every 8 weeks (the total number of injections is 5-6). In Crohn’s disease (severe course) – once 5 microns / kg. In Crohn’s disease with the formation of fistulas – a single dose of 5 mg / kg, re-administered 2 and 6 weeks after the first injection. In the event of a recurrence of the disease, the drug can be prescribed again within 14 weeks after the last dose. To prepare the infusion solution, the contents of the vial are dissolved in 10 ml of water for injection and the total volume is adjusted to 250 ml 0.9% NaCl solution. The resulting solution should be colorless or light yellow and opalescent; it may contain a small amount of small translucent particles (a solution in which dark particles are present or with a changed color is not used). Due to the absence of a preservative in the preparation, the administration of the infusion solution should be started as soon as possible and no later than 3 hours after its preparation. The unused part of the infusion solution is not subject to further use.

Side effects

From the nervous system: headache, dizziness, fainting, depression, psychosis, anxiety, amnesia, apathy, nervousness, drowsiness. From the side of the cardiovascular system: “flushing” of blood to the skin of the face, an increase or decrease in blood pressure, petechiae, thrombophlebitis, bradycardia, palpitations, vasospasm, cyanosis, peripheral circulatory disorders, arrhythmia. From the digestive system: nausea, diarrhea, abdominal pain, dyspepsia, constipation, gastroesophageal reflux, cheilitis, diverticulitis, liver dysfunction, cholecystitis. From the urinary system: urinary tract infections, pyelonephritis. From the genitourinary system: vaginitis. From the musculoskeletal system: myalgia, arthralgia. On the part of the hematopoietic organs: anemia, leukopenia, lymphadenopathy, lymphocytosis, lymphopenia, neutropenia, thrombocytopenia. From the respiratory system: infections of the upper respiratory tract, bronchitis, pneumonia, shortness of breath, sinusitis, epistaxis, bronchospasm, pleurisy. From the sensory organs: conjunctivitis, keratoconjunctivitis, endophthalmitis. On the part of the skin and subcutaneous fat: urticaria, increased sweating, dry skin, eczema, seborrhea, periorbital edema, hyperkeratosis, skin pigmentation disorders, alopecia, bullous rash. Allergic reactions (delayed type): myalgia and / or arthralgia with fever, urticaria, itching, swelling of the face, lips, hands, dysphagia, headache. Other: the formation of autoantibodies, lupus syndrome, excessive fatigue, chest pain, edema, infusion syndrome; viral infections (flu, herpes), abscess, sepsis, bacterial and fungal infections (erysipelas, warts, furunculosis, onychomycosis, cellulitis).

Drug interactions

In patients with rheumatoid arthritis and Crohn’s disease, the simultaneous use of methotrexate or other immunomodulators reduces the formation of antibodies to Remicade and increases the concentration of the latter in plasma.

GCS practically do not affect the pharmacokinetics of Remicade.

It is not recommended to combine treatment with Remicade and Anakinra.

There are no data on the interaction between infliximab and other medicinal products.

Pharmaceutical interactions

Do not mix Remicade solution with other medicinal products during infusion.

Storage conditions

The drug should be stored out of the reach of children at a temperature of 2° to 8°C; do not freeze.

Shelf life

3 years.

Treatment of ulcerative colitis (page 8)

Page 8 of 10

Treatment of ulcerative colitis

The goals of treating a patient with UC are:

• achieving and maintaining remission (clinical, endoscopic, histological),
• minimization of indications for surgical treatment,
• reduction in the incidence of complications and side effects of drug therapy,
• reduction of hospital stay and cost of treatment,
• improving the patient’s quality of life.

The results of treatment largely depend not only on the efforts and qualifications of the doctor, but also on the willpower of the patient, who clearly follows medical recommendations. The modern medicines available in the doctor’s arsenal allow many patients to return to normal life.

The complex of therapeutic measures includes:

• diet (diet therapy)
• taking medications (drug therapy)
• surgical intervention (operative treatment)
• lifestyle change.

Diet therapy. Usually, patients with UC during an exacerbation are recommended a slag-free (with a sharp restriction of fiber) diet, the purpose of which is to mechanically, thermally and chemically spare the inflamed intestinal mucosa. Fiber is limited by exclusion from the diet of fresh vegetables and fruits, legumes, mushrooms, hard, sinewy meat, nuts, seeds, sesame, poppy. With good tolerance, juices without pulp, canned (preferably at home) vegetables and fruits without seeds, ripe bananas are acceptable. Only bakery products and pastries made from refined flour are allowed. With diarrhea, dishes are served warm, wiped, limit foods with a high sugar content. The use of alcohol, spicy, salty foods, dishes with spices is highly undesirable. In case of intolerance to whole milk and lactic acid products, they are also excluded from the patient’s diet.

In severe course of the disease with weight loss, a decrease in the level of protein in the blood, increase the daily amount of protein in the diet, recommending lean meat of animals and birds (beef, veal, chicken, turkey, rabbit), lean fish (perch, pike, pollock ), buckwheat and oatmeal, chicken egg protein. In order to make up for protein losses, artificial nutrition is also prescribed: special nutrient solutions are injected through a vein (more often in a hospital setting) or special nutritional mixtures are administered through the mouth or probe, in which the main food ingredients have been subjected to special processing for their better digestibility (the body does not need to spend its forces to process these substances). Such solutions or mixtures can complement or replace natural nutrition. At present, special nutritional mixtures have already been created for patients with inflammatory bowel diseases, which also contain anti-inflammatory substances.

Non-compliance with the principles of therapeutic nutrition during an exacerbation can lead to an aggravation of clinical symptoms (diarrhea, abdominal pain, the presence of pathological impurities in the stool) and even provoke the development of complications. In addition, it should be remembered that the reaction to various products in different patients is individual. If you notice a deterioration in well-being after eating any product, then after consulting with your doctor, it should also be eliminated from the diet (at least during the period of exacerbation).

Drug therapy is determined by:

• prevalence of colon lesions;
• the severity of UC, the presence of complications of the disease;
• the effectiveness of the previous course of treatment;
• individual patient tolerance to drugs.

Mild to moderate disease can be treated on an outpatient basis. Patients with severe UC require hospitalization. The choice of the necessary medicines by the attending physician is carried out step by step.

In mild to moderate disease, treatment usually begins with 5-aminosalicylates (5-ASA) . These include sulfasalazine and mesalazine. Depending on the extent of the inflammatory process in UC, these drugs are recommended in the form of suppositories, enemas, foams administered through the anus, tablets, or a combination of topical and tablet forms. The drugs reduce inflammation in the colon during a flare-up, are used to maintain remission, and are proven to prevent colon cancer when taken long-term. Side effects often occur while taking sulfasalazine in the form of nausea, headache, increased diarrhea and abdominal pain, and impaired renal function.

If there is no improvement or the disease has a more severe course, then the patient with UC is prescribed hormonal preparations – systemic glucocorticoids (prednisolone, methylprednisolone, dexamethasone). These drugs quickly and effectively cope with the inflammatory process in the intestines. In severe UC, glucocorticoids are administered intravenously. Due to serious side effects (edema, increased blood pressure, osteoporosis, increased blood glucose levels, etc.), they must be taken according to a certain scheme (with a gradual decrease in the daily dose of the drug to a minimum or up to complete withdrawal) under the strict guidance and control of the attending physician. doctor. In some patients, phenomena of steroid refractoriness (lack of response to glucocorticoid treatment) or steroid dependence (resumption of clinical symptoms of exacerbation of UC when trying to reduce the dose or shortly after hormone withdrawal) are noted. It should be noted that during the period of remission, hormonal drugs are not a means of preventing new exacerbations of UC, so one of the goals should be to maintain remission without glucocorticoids.

With the development of steroid dependence or steroid refractoriness, severe or frequently relapsing course of the disease, the appointment of immunosuppressants (cyclosporine, tacrolimus, methotrexate, azathioprine, 6-mercaptopurine) is indicated. The drugs of this group suppress the activity of the immune system, thereby blocking inflammation. Along with this, affecting the immune system, they reduce the resistance of the human body to various infections, and have a toxic effect on the bone marrow.

Cyclosporine, tacrolimus are fast-acting drugs (results are evident in 1-2 weeks). Their timely use in 40-50% of patients with severe UC avoids surgical treatment (removal of the colon). The drugs are administered intravenously or are prescribed in the form of tablets. However, their use is limited by high cost and significant side effects (convulsions, kidney and liver damage, high blood pressure, gastrointestinal disorders, headache, etc.).

Methotrexate is a drug for intramuscular or subcutaneous administration. Its action unfolds in 8 to 10 weeks. When using methotrexate, one also has to reckon with its high toxicity. The drug is prohibited for use in pregnant women, as it causes malformations and fetal death. The effectiveness of the use in patients with UC is being specified.

Azathioprine, 6-mercaptopurine are slow acting drugs. The effect of their reception develops not earlier than in 2-3 months. Drugs can not only cause, but also maintain remission with prolonged use. In addition, the appointment of azathioprine or 6-mercaptopurine allows you to gradually stop taking hormonal drugs. They have fewer side effects compared to other immunosuppressants, they are well combined with 5-ASA preparations and glucocorticoids. However, due to the fact that thiopurines have a toxic effect on the bone marrow in some patients, patients should definitely perform a clinical blood test to monitor this side effect and take timely therapeutic measures.

At the end of the 20th century, a revolution in the treatment of patients with inflammatory bowel diseases (Crohn’s disease, UC) was the use of fundamentally new drugs – biological (anticytokine) drugs. Biologics are proteins that selectively block certain cytokines, key players in the inflammatory process. This selective action contributes to a faster onset of a positive effect and causes fewer side effects compared to other anti-inflammatory drugs. Currently, active work is underway around the world to create and improve new and existing biological drugs (adalimumab, certolizumab, etc. ), and their large-scale clinical trials are being carried out.

In Russia, for the treatment of patients with inflammatory bowel diseases (UC and Crohn’s disease), the only drug of this group is registered so far – infliximab (trade name – Remicade) . Its mechanism of action is to block the multiple effects of the central pro-inflammatory (inflammation-supporting) cytokine, tumor necrosis factor-α. First, in 1998, the drug was licensed in the US and Europe as a reserve drug for the treatment of refractory and fistulous forms of Crohn’s disease. In October 2005, based on the accumulated experience of high clinical efficacy and safety of the use of infliximab in the treatment of patients with UC, a round table devoted to the development of new standards for the treatment of UC and CD in the EU and the USA decided to include infliximab and UC in the list of indications for treatment with infliximab and UC. Since April 2006, infliximab (Remicade) has been recommended for the treatment of patients with severe ulcerative colitis in Russia as well.

Infliximab has become a real breakthrough in modern medicine and is considered the “gold standard”, with which most of the new drugs (adalimumab, certolizumab, etc.) currently under clinical trials are compared.

For UC, infliximab (Remicade) is prescribed:

• for patients who have failed traditional therapy (hormones, immunosuppressants)
• patients dependent on hormonal drugs (cancellation of prednisolone is not possible without the resumption of exacerbation of UC)
• patients with moderate to severe disease, which is accompanied by damage to other organs (extraintestinal manifestations of UC)
• patients who would otherwise require surgical treatment
• patients in whom successful treatment with infliximab caused remission (to maintain it).

Infliximab is given as an intravenous infusion in a treatment room or anticytokine therapy center. Side effects are rare and include fever, joint or muscle pain, and nausea.

Infliximab is faster than prednisolone in terms of symptom relief. So, some patients already feel better within the first 24 hours after the administration of the drug. Abdominal pain, diarrhea, bleeding from the anus are reduced. There is a restoration of physical activity, appetite increases. For some patients, for the first time, hormone withdrawal becomes possible, for others, saving the colon from surgical removal. Due to the positive effect of infliximab on the course of severe forms of UC, the risk of complications and deaths is reduced.

This drug is not only indicated to achieve remission of UC, but can also be administered as an intravenous infusion over a long period of time as maintenance therapy.

Infliximab (Remicade) is currently one of the best studied drugs with an optimal benefit/risk profile. Infliximab (Remicade) is even approved for use in children over 6 years of age.

However, biologics are not without side effects. By suppressing the activity of the immune system, as well as other immunosuppressants, they can lead to an increase in infectious processes, in particular tuberculosis. Therefore, before prescribing infliximab, patients should undergo chest x-ray and other studies for the timely diagnosis of tuberculosis (for example, the quantiferon test is the “gold standard” for detecting latent tuberculosis abroad).

A patient treated with infliximab, as with any new agent, should be monitored closely by their physician or anticytokine specialist.

Prior to the first infliximab (Remicade) infusion, patients undergo the following tests:

• chest X-ray
• Mantoux skin test
• blood test.

Chest x-ray and Mantoux skin test are done to rule out latent TB. A blood test is necessary to assess the general condition of the patient and rule out liver disease. If an active severe infection (eg, sepsis) is suspected, other investigations may be required.

Infliximab (Remicade) is given directly into a vein, by drip, as an intravenous infusion, slowly. The procedure takes approximately 2 hours and requires constant monitoring by medical personnel.

The standard recommended single dose dose of infliximab in patients with UC is 5 mg/kg body weight.

An example of calculating the single dose of infliximab required for a single infusion. For a patient weighing 60 kg, a single dose of infliximab is: 5 mg x 60 kg = 300 mg (3 x 100 mg Remicade vials).

Infliximab (Remicade), in addition to therapeutic efficacy, provides patients with a sparing regimen of therapy. In the first 1.5 months at the initial, so-called induction stage of therapy, the drug is administered intravenously only 3 times with a gradually increasing interval between subsequent injections carried out under the supervision of a physician. At the end of the induction period, the doctor evaluates the effectiveness of treatment in this patient and, if there is a positive effect, recommends continuing therapy with infliximab (Remicade), usually according to the scheme once every 2 months (or every 8 weeks). It is possible to adjust the dose and mode of administration of the drug, depending on the individual course of the disease in a particular patient.