Impact of infliximab therapeutic drug level monitoring on outcomes of patients with inflammatory bowel disease: A real-world experience from a Middle Eastern cohort |
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| Authors: | Nahla Azzam Abdulrahman Aljebreen Othman Alharbi Aline Charabaty Mohammed Alanazi Nashmi Alkuwaykibi Jowaher Alfaraidi Ahmad Bashamil Tarik Almansour Majid Almadi |
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| Institution: | 1. Division of Gastroenterology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia;2. Division of Gastroenterology, Department of Internal Medicine, Johns Hopkins Medicine, Washington, DC, United States;3. Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, Mc, Canada;1. Department of Gastroenterology, The Second Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China;2. Endoscopy Center, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, PR China;1. Faculty of Medicine, Cairo University, Cairo, Egypt;2. Misr International University, Cairo, Egypt;3. Damanhour Medical National Institute, Ministry of Health and Population, Beheira, Egypt;1. Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran;2. Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran;3. Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran;1. Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China;2. Department of Gastroenterology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518000, China;3. School of Mathematical Sciences, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China;4. Department of Preventive Medicine, Jinggangshan University, Ji''an, Jiangxi 343009, China;1. Nantong University, School of Public Health, Nantong City, Jiangsu Province, China;2. Nantong Health College of Jiangsu Province, Nantong City, Jiangsu Province, China;3. Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nantong University, China;1. Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, Fuzhou, China;2. Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China;3. Oriental Hospital Affiliated to Xiamen University, Fuzhou, China |
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| Abstract: | Background and study aimTherapeutic drug monitoring (TDM) through measurement of infliximab (IFX) trough levels and antibodies to infliximab (ATI) is performed to guide IFX intensification strategies and improve its efficacy. We conducted this study to explore the relationship between clinical and endoscopic/radiological remission and IFX and ATI levels in patients with inflammatory bowel disease (IBD) treated with IFX and to evaluate the appropriateness of treatment decision post TDM.Patients and methodsThis was a cross-sectional study of a cohort of adult patients with IBD. Serum IFX trough concentrations and ATI were measured.ResultsA total of 129 patients 104] with ulcerative colitis (UC) and 25 with Crohn’s disease (CD)] were included in this study, of whom 61.2% were men. The mean disease duration was 6.7 years, and 72% of patients with UC had extensive colitis. The mean serum IFX trough level was 4.1 µg/mL; the IFX trough levels were subtherapeutic in 75 patients (58%), therapeutic in 37 patients (29%), and supratherapeutic in 17 patients (13%). Positivity to ATI was found in 16 patients (12.4%). Only 43 patients (33.3%) underwent an appropriate change in therapy after TDM, patients with penetrating CD disease had low IFX levels and higher C-reactive protein levels at 12 months before TDM.ConclusionsPatients with IBD with therapeutic IFX levels tend to have increased endoscopic/radiological remission rates. However, an appropriate change in management based on TDM was absent in the majority of patients, potentially reflecting the need to have a dashboard to support and guide clinicians in decision-making. |
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| Keywords: | Inflammatory bowel disease Crohn’s disease Ulcerative colitis Trough levels Antibodies toward infliximab |
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