Abstract | BACKGROUND:
Infliximab (IFX) is effective in the treatment of inflammatory bowel disease; however, the effect is often not durable. It is unknown if proactive therapeutic concentration monitoring (TCM) of IFX improves outcomes. METHODS: This is a retrospective observational study examining the use of proactive TCM and titration of IFX to a target concentration for patients with inflammatory bowel disease in clinical remission at a tertiary care center. The primary aim was to describe the clinical course of patients who had proactive TCM. A secondary analysis was done to assess if this strategy was superior to the standard of care. RESULTS: Forty-eight patients were identified as having proactive TCM. Fifteen percent had an initial undetectable trough concentration. Twenty-five percent (12 of 48) of patients escalated IFX after the first proactive TCM while 15% (7 of 48) of patients de-escalated IFX therapy over the study period. A control group of 78 patients was identified. Patients who had proactive TCM had a greater probability of remaining on IFX than controls (hazard ratio, 0.3; 95% confidence interval, 0.1-0.6; log rank test; P = 0.0006). The probability of remaining on IFX was greatest for patients who achieved a trough concentration >5 μg/mL (hazard ratio, 0.03; 95% confidence interval, 0.01-0.1; P < 0.0001 versus trough <5 μg/mL). Fewer patients in the proactive TCM group stopped IFX (10% versus 31%, P = 0.009). CONCLUSIONS: In this pilot observational study, proactive TCM of IFX frequently identified patients with low or undetectable trough concentrations and resulted in a greater probability of remaining on IFX.
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Authors | Byron P Vaughn, Manuel Martinez-Vazquez, Vilas R Patwardhan, Alan C Moss, William J Sandborn, Adam S Cheifetz |
Journal | Inflammatory bowel diseases
(Inflamm Bowel Dis)
Vol. 20
Issue 11
Pg. 1996-2003
(Nov 2014)
ISSN: 1536-4844 [Electronic] England |
PMID | 25192499
(Publication Type: Comparative Study, Journal Article, Observational Study, Research Support, N.I.H., Extramural)
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Chemical References |
- Antibodies, Monoclonal
- Gastrointestinal Agents
- Infliximab
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Topics |
- Adult
- Antibodies, Monoclonal
(pharmacokinetics, therapeutic use)
- Case-Control Studies
- Drug Monitoring
- Female
- Follow-Up Studies
- Gastrointestinal Agents
(pharmacokinetics, therapeutic use)
- Humans
- Inflammatory Bowel Diseases
(blood, drug therapy, immunology)
- Infliximab
- Male
- Middle Aged
- Pilot Projects
- Prognosis
- Retrospective Studies
- Tissue Distribution
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