Article Text

other Versions

PDF
Trough Serum Infliximab: A Predictive Factor Of Clinical Outcome For Infliximab Therapy In Acute Ulcerative Colitis
  1. Cynthia H Seow (cynthia.seow{at}albertahealthservices.ca)
  1. Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, Canada
    1. Alvin Newman (anewman{at}mtsinai.on.ca)
    1. Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, Canada
      1. Susan P Irwin (sueirwin2{at}yahoo.ca)
      1. Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, Canada
        1. A Hillary Steinhart (hsteinhart{at}mtsinai.on.ca)
        1. Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, Canada
          1. Mark S Silverberg (msilverberg{at}mtsinai.on.ca)
          1. Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, Canada
            1. Gordon R Greenberg (ggreenberg{at}mtsinai.on.ca)
            1. Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, Canada

              Abstract

              Background & Aims: Antibodies to infliximab reduce serum infliximab with loss of clinical benefit, but undetectable trough serum concentrations of infliximab may occur without antibody formation. The relation between trough serum infliximab and clinical outcomes was evaluated in acute ulcerative colitis.

              Methods: In a cohort of 115 ulcerative colitis patients treated with 3-dose induction followed by scheduled maintenance infliximab, rates of clinical remission, colectomy, antibodies to infliximab and trough serum infliximab were determined.

              Results: Rates of remission were 32% at week 10 and 37% at week 54. Colectomy occurred in 40% of patients, at a median of 5.3 (IQR: 1.9-12.1) months. Detectable trough serum infliximab was present in 39% of patients and among patients with undetectable infliximab, 41% were antibody positive and 20% were antibody negative. For antibody positive and antibody negative patients, rates of remission (18% vs. 14%), endoscopic improvement (25% vs. 35%) and colectomy (52% vs. 59%) were not different. A detectable serum infliximab was associated with higher rates of remission (69% vs. 15%; P <0.001) and endoscopic improvement (76% vs. 28%, P <0.001). An undetectable serum infliximab predicted an increased risk for colectomy (55% vs. 7%, odds ratio 9.3; 95% confidence interval, 2.9 - 29.9; P <0.001). Concurrent immunosuppression was not associated with clinical outcomes.

              Conclusions: For ulcerative colitis patients treated with infliximab, a detectable trough serum infliximab predicts clinical remission, endoscopic improvement, and a lower risk for colectomy. In assessing clinical outcomes to infliximab, the presence of antibodies to infliximab is a surrogate for absent drug.

              Statistics from Altmetric.com

              Request permissions

              If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

              Linked Articles

              • Commentary
                Paul Rutgeerts Severine Vermeire Gert Van Assche
              • Digest
                BMJ Publishing Group Ltd and British Society of Gastroenterology