AI Article Synopsis
- Infliximab is an effective treatment for Crohn's disease and ulcerative colitis, but the importance of monitoring drug levels and antibodies during maintenance therapy is still not fully understood.
- A study involving 79 patients found that higher serum levels of infliximab were linked to clinical remission, while lower levels were associated with disease flare-ups.
- The research suggested that a trough level of 4.1μg/mL could be a key indicator of clinical remission, and most patients with undetectable levels had developed antibodies against infliximab, especially those not taking additional immunosuppressive therapy.
Article Abstract
Background And Aims: The anti-TNF antibody infliximab is effective in inducing remission in Crohn's disease as well as in ulcerative colitis and many patients are treated for several years with sustained clinical remission. However, the role of monitoring s-infliximab and antibodies towards infliximab during maintenance treatment remains unclear. Our aim was to correlate serum drug levels and antibodies to clinical activity, CRP, albumin and concomitant immunosuppression in a cohort on maintenance infliximab treatment.
Methods: We included 79 patients with Crohn's disease or ulcerative colitis who had responded to infliximab and received maintenance treatment (4-69 infusions) in this retrospective study. Infliximab levels and antibodies towards the drug were analyzed with in-house-developed ELISA assays.
Results: The mean s-infliximab was significantly higher in patients in remission (4.1μg/mL) as compared with disease flare (mean 1.8μg/mL); p<0.001. The s-infliximab showed a significant negative correlation with Harvey-Bradshaw index (r=-0.21; p<0.05). Serum-infliximab progressively decreased with the number of accumulated infusions (p<0.05). In patients with undetectable trough levels, 55% of the patients with concomitant immunosuppressive were positive for antibodies against infliximab, as compared with 94% of patients on monotherapy. Patients with undetectable serum-infliximab were in clinical remission at 25% of the visits.
Conclusions: The trough level 4.1μg/mL may serve as cut-off for clinical remission. Drug trough levels decreased during treatment and almost all patients with undetectable s-infliximab and monotherapy had developed antibodies against the drug.
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| http://dx.doi.org/10.1016/j.crohns.2014.01.009 | DOI Listing |
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