Indications: severe, active and progressive rheumatoid arthritis in patients not previously treated with methotrexate; psoriasis; inflammatory bowel disease.

Cautions: hepatic impairment; renal impairment; monitor for infections before, during, and for 6 months after treatment; heart failure (discontinue if symptoms develop or worsen; avoid in moderate or severe heart failure); demyelinating CNS disorders (risk of exacerbation); Hypersensitivity reactions.

Contra-indications: pregnancy; breast-feeding; severe infections

Side Effects: dyspepsia, diarrhoea, constipation, hepatitis, cholecystitis, diverticulitis, gastro-intestinal haemorrhage, flushing, bradycardia, arrhythmias, palpitation, syncope, vasospasm, peripheral ischaemia, ecchymosis, haematoma, interstitial pneumonitis or fibrosis, fatigue, anxiety, drowsiness, dizziness, insomnia, confusion, agitation, amnesia, seizures, demyelinating disorders, vaginitis, myalgia, arthralgia, endophthalmitis, rash, sweating, hyperkeratosis, skin pigmentation, alopecia.

Dose: By intravenous infusion, rheumatoid arthritis (in combination with methotrexate), adult over 18 years, 3mg/kg, repeated 2 weeks and 6 weeks after initial infusion, then every 8 weeks; discontinue if no response by 12 weeks of initial infusion.

Ankylosing spondylitis, adult over 18 years, 5mg/kg, repeated 2 weeks and 6 weeks after initial infusion, then every 6–8 weeks; discontinue if no response by 6 weeks of initial infusion.

Psoriatic arthritis (in combination with methotrexate),

adult over 18 years, 5mg/kg, repeated 2 weeks and 6 weeks after initial infusion, then every 8 weeks Psoriasis, adult over 18 years, 5mg/kg, repeated 2 weeks and 6 weeks after initial infusion, then every 8 weeks; discontinue if no response by 14 weeks of initial infusion.