Data on the value of therapeutic drug monitoring of infliximab to predict mucosal healing in inflammatory bowel diseases (IBD) are scarce.
Dr Stephane Paul and colleagues found that consecutive patients with IBD receiving ongoing infliximab treatment and developing secondary failure to infliximab were enrolled in a prospective study between 2010 and 2011.
Infliximab trough levels, antibodies to infliximab concentrations, C-reactive protein levels, and fecal calprotectin were measured before infliximab optimization and at week 8.
The team performed a proctosigmoidoscopy on the day of first infliximab optimization, and at week 8 in all patients with ulcerative colitis.
|A delta infliximab more than 0.5 μg/mL was associated with mucosal healing|
|Inflammatory Bowel Diseases|
MH was defined by fecal calprotectin less than 250 μg/g stools in Crohn's disease, and by an endoscopic Mayo score of 0 or 1 in ulcerative colitis.
The researchers included 52 patients with IBD, of which 34 patients with Crohn's disease, and 18 patients with ulcerative colitis.
After infliximab dose intensification, half of Crohn's disease and ulcerative colitis patients achieved mucosal healing.
The research team found that an increase in infliximab trough levels was associated with mucosal healing in both Crohn's disease and ulcerative colitis.
A delta infliximab more than 0.5 μg/mL was associated with mucosal healing, area under the receiver operating characteristics.
The researchers found that the only factor associated with mucosal healing after infliximab optimization was a delta infliximab more than 0.5 µg/mL in patients with IBD.
Dr Paul's team concludes, "Therapeutic drug monitoring of infliximab strongly predicts the likelihood of achieving MH following infliximab dose intensification in both Crohn's disease and ulcerative colitis."