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The Utility of Infliximab Therapeutic Drug Monitoring among Patients with Inflammatory Bowel Disease and Concerns for Loss of Response: A Retrospective Analysis of a Real-World Experience

View Article: PubMed Central - PubMed

ABSTRACT

Background. Infliximab (IFX) therapeutic drug monitoring (TDM) allows for objective decision making in patients with inflammatory bowel disease (IBD) and loss of response. Questions remain about whether IFX TDM improves outcomes. Methods. Patients with IBD who had IFX TDM due to concerns for loss of response were considered for inclusion. Serum IFX trough concentration and anti-drug antibody (ADA) concentrations were measured. Patients were grouped by TDM results: group 1, low IFX/high ADA; group 2, low IFX/low ADA; group 3, therapeutic IFX. Changes in management were analyzed according to groupings; remission rates were assessed at 6 months. Results. 71 patients were included of whom 37% underwent an appropriate change in therapy. Groups 1 (67%) and 2 (83%) had high adherence compared to only 9% in group 3. At 6 months, 57% had achieved remission. More patients who underwent an appropriate change in therapy achieved remission, though this did not reach statistical significance (69% versus 49%; P = 0.098). Conclusions. A trend towards increased remission rates was associated with appropriate changes in management following TDM results. Many patients with therapeutic IFX concentrations did not undergo an appropriate change in management, potentially reflecting a lack of available out-of-class options at the time of TDM or due to uncertainty of the meaning of the reported therapeutic range.

No MeSH data available.


Related in: MedlinePlus

Remission at 6 months separated by group following infliximab therapeutic drug monitoring in inflammatory bowel disease patients with concerns for loss of response.
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fig3: Remission at 6 months separated by group following infliximab therapeutic drug monitoring in inflammatory bowel disease patients with concerns for loss of response.

Mentions: The overall remission rate at a mean follow-up time of 6 months after TDM was 57%. Fifty percent of UC and 60% of CD patients achieved remission at follow-up. Remission rates by TDM result grouping are depicted in Figure 3 (Figure 3). When comparing the impact of appropriate clinical decision making after TDM on remission rates, we observed that more patients who underwent an appropriate change in therapy achieved remission, although this did not reach statistical significance (69% versus 49%, P = 0.098) (Figure 4). Within group 3, 15/43 patients underwent dose optimization (35%); six of these patients achieved remission (6/15, 40%). Of the 39 patients in remission at 6 months, 22 had objective evidence of disease at the time of TDM (22/39, 56%). Among the subgroup of patients with objective evidence of disease at the time of TDM (n = 45), 6-month remission rates were slightly higher in those patients where a correct TDM decision was made compared to those where an incorrect TDM decision was made, but this did not reach statistical significance (56% versus 48%, P = 0.625).


The Utility of Infliximab Therapeutic Drug Monitoring among Patients with Inflammatory Bowel Disease and Concerns for Loss of Response: A Retrospective Analysis of a Real-World Experience
Remission at 6 months separated by group following infliximab therapeutic drug monitoring in inflammatory bowel disease patients with concerns for loss of response.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121455&req=5

fig3: Remission at 6 months separated by group following infliximab therapeutic drug monitoring in inflammatory bowel disease patients with concerns for loss of response.
Mentions: The overall remission rate at a mean follow-up time of 6 months after TDM was 57%. Fifty percent of UC and 60% of CD patients achieved remission at follow-up. Remission rates by TDM result grouping are depicted in Figure 3 (Figure 3). When comparing the impact of appropriate clinical decision making after TDM on remission rates, we observed that more patients who underwent an appropriate change in therapy achieved remission, although this did not reach statistical significance (69% versus 49%, P = 0.098) (Figure 4). Within group 3, 15/43 patients underwent dose optimization (35%); six of these patients achieved remission (6/15, 40%). Of the 39 patients in remission at 6 months, 22 had objective evidence of disease at the time of TDM (22/39, 56%). Among the subgroup of patients with objective evidence of disease at the time of TDM (n = 45), 6-month remission rates were slightly higher in those patients where a correct TDM decision was made compared to those where an incorrect TDM decision was made, but this did not reach statistical significance (56% versus 48%, P = 0.625).

View Article: PubMed Central - PubMed

ABSTRACT

Background. Infliximab (IFX) therapeutic drug monitoring (TDM) allows for objective decision making in patients with inflammatory bowel disease (IBD) and loss of response. Questions remain about whether IFX TDM improves outcomes. Methods. Patients with IBD who had IFX TDM due to concerns for loss of response were considered for inclusion. Serum IFX trough concentration and anti-drug antibody (ADA) concentrations were measured. Patients were grouped by TDM results: group 1, low IFX/high ADA; group 2, low IFX/low ADA; group 3, therapeutic IFX. Changes in management were analyzed according to groupings; remission rates were assessed at 6 months. Results. 71 patients were included of whom 37% underwent an appropriate change in therapy. Groups 1 (67%) and 2 (83%) had high adherence compared to only 9% in group 3. At 6 months, 57% had achieved remission. More patients who underwent an appropriate change in therapy achieved remission, though this did not reach statistical significance (69% versus 49%; P = 0.098). Conclusions. A trend towards increased remission rates was associated with appropriate changes in management following TDM results. Many patients with therapeutic IFX concentrations did not undergo an appropriate change in management, potentially reflecting a lack of available out-of-class options at the time of TDM or due to uncertainty of the meaning of the reported therapeutic range.

No MeSH data available.


Related in: MedlinePlus