Remicade for Ulcerative Colitis – An Effective Therapy

David Fuller

Last Updated On: July 9, 2025

Ulcerative colitis, a chronic inflammatory condition affecting the colon, is on the rise in the United States, with an alarming 125% increase in cases from 2007 to 2016. Today, around 451,776 adults live with this condition, which often causes debilitating symptoms like bloody diarrhea, severe abdominal pain, and an urgent need to use the bathroom. The disease can significantly disrupt daily life and overall quality of life for many individuals.

To address this growing challenge, biologic therapies such as Remicade (infliximab) have emerged as key treatment options. By targeting tumor necrosis factor-alpha (TNF-α), Remicade effectively reduces inflammation, helping patients with moderate to severe ulcerative colitis achieve remission when traditional treatments fall short.

In this article, we’ll take a deeper dive into how Remicade works, its effectiveness in managing ulcerative colitis, potential side effects, and what patients can expect throughout their treatment journey.

Key Takeaways

• Remicade (infliximab) is a powerful biologic therapy that treats moderate to severe ulcerative colitis by targeting TNF-α, a pro-inflammatory cytokine involved in the disease’s progression.
• It reduces inflammation, promoting tissue healing and helping patients achieve clinical remission when other treatments fail.
• Induction therapy involves infusions at weeks 0, 2, and 6 to quickly reduce symptoms, while the maintenance phase typically consists of infusions every 8 weeks to sustain remission.
• For patients who don’t respond to the standard dosing, dose escalation or more frequent infusions (every 6 weeks) may be necessary, although off-label intensification is common practice.
• Doctors inject Remicade intravenously. For other biologics, such as adalimumab, patients can self-administer, but they may take longer to show results.
• The ideal candidates for Remicade are those with moderate to severe disease, steroid dependence, or those who haven’t responded to conventional therapies. Screening for tuberculosis and hepatitis is mandatory prior to initiating treatment.
• Long-term data shows that Remicade offers sustained remission for many patients and can reduce the need for corticosteroids and hospitalizations.
• Safety monitoring, including vital sign checks and blood tests, is essential during treatment to ensure proper dosing and minimize risks.

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How Remicade Works to Control Ulcerative Colitis Inflammation

Remicade contains the active ingredient infliximab, a monoclonal antibody designed to block tumor necrosis factor-alpha (TNF-α), a key protein involved in the inflammation process seen in ulcerative colitis (UC). TNF-α is a pro-inflammatory cytokine that contributes to the overactive immune response that causes the damage to the colon lining in UC patients.

By neutralizing TNF-α, this innovative product from the Remicade manufacturer interrupts the inflammatory cascade, helping to reduce symptoms like bloody diarrhea and abdominal pain, facilitating tissue healing, and inducing clinical remission in patients who haven’t responded to other treatments. 

Administering Remicade intravenously ensures the direct delivery of the medication into the bloodstream. This provides a systemic approach that targets inflammation not just in the colon but also in extraintestinal areas where symptoms may occur.

Evidence Supporting Remicade Use in Moderate to Severe UC

Remicade was the first anti-TNF biologic to receive FDA approval for the treatment of ulcerative colitis. Pivotal clinical trials, such as the ACT 1 and ACT 2 studies, support this approval. In these studies, Remicade demonstrated significant improvements in UC patients, including higher remission rates and mucosal healing.

Mucosal healing is a crucial indicator of long-term success in managing UC, and these trials proved that Remicade can achieve this in a majority of patients.

Long-term data also shows that, with proper dosing, many patients can maintain remission for several years, leading to reduced reliance on corticosteroids and lower rates of hospitalization or surgery. Remicade’s clinical efficacy is well-established, making it a preferred option for treating moderate to severe UC, especially in patients who require rapid symptom control.

How Remicade Compares to Other Ulcerative Colitis Biologics

Remicade is part of a growing class of biologic therapies for UC, which includes adalimumab (Humira), vedolizumab (Entyvio), and ustekinumab (Stelara). When deciding between biologic therapies, the choice depends on factors such as disease severity, patient preferences, and prior treatment responses.

• Remicade works quickly, and many patients notice improvements after the first or second infusion. This rapid onset is particularly beneficial for patients with severe symptoms or those experiencing acute flare-ups.
  
• Remicade is administered intravenously in a clinical setting, ensuring the complete and controlled absorption of the medication. This reduces variability in how the body metabolizes the drug, providing a more consistent treatment experience.
  
• Patients can self-administer other biologics like adalimumab (Humira) subcutaneously. This can be more convenient for stable patients but may take longer to show results compared to Remicade‘s rapid effect.

With a proven track record, Remicade remains a first-line therapy in many treatment regimens due to its well-documented outcomes, particularly in hospitalized or steroid-dependent patients. Physician familiarity and the drug’s ability to deliver fast, reliable results make it an appealing choice for patients seeking rapid symptom relief.

What to Expect During Remicade Induction and Maintenance

Remicade therapy is divided into induction and maintenance phases. The induction phase typically consists of infusions at weeks 0, 2, and 6, designed to reduce inflammation and control symptoms rapidly. Many patients begin to notice significant improvement by the second or third dose.

After successful induction, patients transition to the maintenance phase, with infusions every 8 weeks to sustain remission and prevent flare-ups. In cases of high inflammatory markers or recurring symptoms, some patients may require more frequent infusions, typically every 6 weeks, or even a dose escalation to 10 mg/kg to maintain effectiveness. 

Although the FDA label for infliximab doesn’t specify dose escalation for ulcerative colitis, patients who experience a loss of response can get off-label intensification.

Patients receiving Remicade undergo IV infusions lasting approximately 2 hours in a clinical setting. Afterward, healthcare providers monitor vital signs to detect any early signs of infusion reactions. They may also premedicate with antihistamines or acetaminophen to minimize side effects such as fever, chills, or itching.

Optimizing Patient Selection for Remicade Treatment

Remicade is most suitable for patients with moderate to severe ulcerative colitis who have not responded to traditional treatments such as corticosteroids or mesalamine. The ideal candidates include:

• Hospitalized patients with acute severe colitis.
  
• Patients who relapse when tapering off steroids.
  
• Those who prefer IV therapy with regular provider supervision.
  
• Individuals with rapid or severe flare-ups who need fast symptom control.

Before starting treatment, patients must undergo screening for tuberculosis and hepatitis. The healthcare provider will also assess medical history, infection risk, and the likelihood of developing antibodies against the drug.

Conclusion

Remicade remains a cornerstone in the treatment of ulcerative colitis, especially for those with moderate to severe disease. With its well-established safety profile, long-term clinical data, and reliable manufacturer backing from Janssen Biotech, Inc., it continues to be a first-line option in many treatment plans. 

When managed properly, Remicade offers patients real hope for long-term remission and an improved quality of life.

FAQs

1. How long does it take for Remicade to work in UC patients?

Most patients report initial symptom relief within 2–6 weeks after their first or second infusion, with some noticing improvements even sooner. The full therapeutic effect typically develops over the first 8 weeks of induction.

2. Can Remicade be used long-term for ulcerative colitis?

Yes. Remicade maintenance infusions every 8 weeks can continue for years. Long-term studies show many patients sustain steroid-free remission and avoid hospitalization or surgery with proper monitoring and dosing adjustments.

3. Is Remicade safe to use during pregnancy?

Remicade is classified as FDA Pregnancy Category B. Animal data show no fetal harm, and human registries (≈450 exposures) have not demonstrated an increased risk of congenital malformations. It does cross the placenta, so use during pregnancy should be under close medical supervision.

4. Can I receive vaccines while on Remicade?

Live-attenuated vaccines like MMR or varicella are contraindicated during and for at least three months after Remicade treatment due to infection risk. Inactivated vaccines, including influenza and pneumococcal vaccines, are safe and strongly recommended to reduce the likelihood of serious infections.

References

Berre CL, Honap S, Peyrin-Biroulet L. Ulcerative colitis. The Lancet. 2023;402(10401):571-584. doi:10.1016/s0140-6736(23)00966-2

Remicade: Uses, Dosage & Side Effects. Drugs.com. https://www.drugs.com/remicade.html

Levin A, Shibolet O. Infliximab in ulcerative colitis. Biologics. 2008;2(3):379-388. doi:10.2147/btt.s2249

Remicade: package insert / prescribing information. Drugs.com. https://www.drugs.com/pro/remicade.html