Trough Levels and Antibodies to Infliximab May Not Predict Response to Intensification of Infliximab Therapy in Patients With Inflammatory Bowel Disease

英夫利昔单抗 医学 内科学 胃肠病学 炎症性肠病 阿达木单抗 槽水位 外科 疾病 他克莫司 移植
作者
Benjamin Pariente,Guillaume Pineton de Chambrun,Roman Krzysiek,Marine Desroches,Gauthier Louis,Chiara De Cassan,Clotilde Baudry,Jean–Marc Gornet,Pierre Desreumaux,Dominique Émilie,Jean–Frédéric Colombel,Matthieu Allez
出处
期刊:Inflammatory Bowel Diseases [Oxford University Press]
卷期号:18 (7): 1199-1206 被引量:108
标识
DOI:10.1002/ibd.21839
摘要

Infliximab is effective for the treatment of refractory inflammatory bowel disease (IBD). Nevertheless, up to 40% of patients lose response to infliximab over time. The aim was to assess the clinical value of measuring infliximab trough levels and antibodies to infliximab (ATI) concentrations in IBD patients who lost response to infliximab therapy. We retrospectively studied records of IBD patients who lost response to infliximab therapy. We first assessed clinical responses of different therapeutic strategies that were applied when patients lost response to infliximab and then we looked at the correlation between clinical response and infliximab trough levels and ATI concentrations. Seventy-six IBD patients were included. 31/76 patients (41%) continued infliximab therapy without any modification, 39 patients (51%) had an intensification of infliximab therapy, five patients (7%) had switched to adalimumab therapy, and one patient (1%) underwent surgery. Clinical response was observed in 27 patients (69%) with an intensification of infliximab therapy. There was no significant difference in mean infliximab trough level at inclusion in patients who responded to intensification of infliximab therapy (3.3 ± 4.1 μg/mL) as compared with patients who did not respond (2.3 ± 2.2 μg/mL, P = 0.85). In all, 16/76 patients (22.4%) presented detectable ATI in the serum. Ten ATI-positive patients had an intensification of infliximab therapy and six (60%) demonstrated a clinical response. After intensification of infliximab therapy the ATI concentration decreased in five patients. In patients with IBD who lose response to infliximab, clinical improvement may occur upon intensification of infliximab therapy, irrespective of infliximab serum concentration or presence of ATI.
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