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Antibodies to infliximab have been associated with loss of clinical response and lower serum infliximab levels in some studies of patients with inflammatory bowel disease (IBD). This has important implications for patient management and development of novel biologic therapies. Dr Kavinderjit Nanda from Massachusetts, USA performed a systematic review and meta-analysis of studies that reported clinical outcomes and infliximab levels according to patients’ Antibodies to infliximab status. MEDLINE, Web of Science, CINAHL, Scopus, and EMBASE were searched for eligible studies. The researchers reported quality assessment was undertaken using GRADE criteria. Raw data from studies meeting inclusion criteria was pooled for meta-analysis of effect estimates. Sensitivity analysis was performed for all outcomes. The team of doctors reported that a funnel plot was performed to assess for publication bias. The team identified 13 studies that met the inclusion criteria, and reported results in 1,378 patients with inflammatory bowel disease. All included studies had a high risk of bias in at least 1 quality domain. The team of researchers found that the pooled risk ratio of loss of clinical response to infliximab in patients with IBD who had antibodies to infliximab was 3.2, when compared with patients without antibodies to infliximab. This effect estimate was predominantly based on data from patients with Crohn's disease. The doctors found that data only from patients with ulcerative colitis exhibited a non-significant relative risk of loss of response of 2.2 in those with antibodies to infliximab.  | | The standardized mean difference in trough serum infliximab levels between groups was −0.8 | | American Journal of Gastroenterology |
Heterogeneity existed between studies, in both methods of antibodies to infliximab detection, and clinical outcomes reported. The team observed that 3 studies reported trough serum infliximab levels according to antibodies to infliximab status. The standardized mean difference in trough serum infliximab levels between groups was −0.8. A funnel plot suggested the presence of publication bias. Dr Nanda's team concludes, "The presence of antibodies to infliximab is associated with a significantly higher risk of loss of clinical response to infliximab and lower serum infliximab levels in patients with inflammatory bowel disease." "Published studies on this topic lack uniform reporting of outcomes." "High risk of bias was present in all the included studies."
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