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Correlation Between Anti-TNF Serum Levels and Endoscopic Inflammation in Inflammatory Bowel Disease Patients. Dig Dis Sci 2019; 64:846-854. [PMID: 30426297 DOI: 10.1007/s10620-018-5362-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES (a) To evaluate the diagnostic accuracy of anti-TNF trough levels to predict mucosal healing in inflammatory bowel disease (IBD); (b) to determine the best cut-off point to predict mucosal healing in IBD patients treated with anti-TNF. METHODS This is a multicenter, prospective study. IBD patients under anti-TNF treatment for at least 6 months that had to undergo an endoscopy were included. Mucosal healing was defined as: Simple endoscopic score for Crohn's Disease < 3 for Crohn's disease (CD), Rutgeerts score < i2 for CD in postoperative setting, or Mayo endoscopic score ≤ 1 for ulcerative colitis (UC). Anti-TNF concentrations were measured using SMART ELISAs at trough. RESULTS A total of 182 patients were included. Anti-TNF trough levels were significantly higher among patients that had mucosal healing than among those who did not. The area under the curve of infliximab for mucosal healing was 0.63 (best cutoff value 3.4 μg/mL), and for adalimumab 0.60 (best cutoff value 7.2 μg/mL). In the multivariate analysis, having anti-TNF drug levels above the cutoff values [odds ratio (OR) 3.1]) and having UC instead of CD (OR 4) were associated with a higher probability of having mucosal healing. Additionally, the need for an escalated dosage (OR 0.2) and current smoking habit (OR 0.2) were also associated with a lower probability of mucosal healing. CONCLUSIONS There was an association between anti-TNF trough levels and mucosal healing in IBD patients; however, the accuracy of the determination of infliximab and adalimumab concentrations able to predict mucosal healing was suboptimal.
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Rodríguez-Lago I, Ferreiro-Iglesias R, Nos P, Gisbert JP. Manejo de la colitis ulcerosa aguda grave en España: Resultados de una encuesta sobre práctica clínica. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:90-101. [DOI: 10.1016/j.gastrohep.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 12/23/2022]
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Jain S, Ahuja V, Limdi JK. Optimal management of acute severe ulcerative colitis. Postgrad Med J 2019; 95:32-40. [PMID: 30636193 DOI: 10.1136/postgradmedj-2018-136072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/09/2018] [Accepted: 12/01/2018] [Indexed: 12/12/2022]
Abstract
Acute severe ulcerative colitis is a life-threatening medical emergency, which can be associated with significant morbidity and is preventable through prompt and effective management. Corticosteroids remain the cornerstone of initial therapy, although a third of patients will not respond. Further management hinges on timely decisions with use of rescue therapy with ciclosporin or infliximab, without compromising the health or safety of the patient, or timely surgery. Although such patients need specialist care, it is imperative that emergency care physicians are aware of the important principles of management of this condition to achieve successful outcomes. Risk stratification and the use of predictive models using clinical parameters have reduced the morbidity associated with this condition.We discuss current evidence and present a clinical approach to clinicians involved in the emergency care of patients with acute severe ulcerative colitis in this review.
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Affiliation(s)
- Saransh Jain
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Jimmy K Limdi
- Department of Gastroenterology, Inflammatory Bowel Diseases Section, University of Manchester, Manchester, UK
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Whaley KG, Rosen MJ. Contemporary Medical Management of Acute Severe Ulcerative Colitis. Inflamm Bowel Dis 2019; 25:56-66. [PMID: 29889235 PMCID: PMC6290785 DOI: 10.1093/ibd/izy208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Indexed: 02/07/2023]
Abstract
Acute severe ulcerative colitis is a medical emergency that requires prompt recognition, evaluation, and intervention. Patients require hospital admission with laboratory, radiographic, and endoscopic evaluation with initiation of corticosteroid treatment. Despite early intervention, many patients require salvage medical therapy, with some progressing to colectomy. Here we review important concepts and recent advances in the evaluation and medical management of adult and pediatric patients with acute severe ulcerative colitis.
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Affiliation(s)
- Kaitlin G Whaley
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael J Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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55
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Figueroa C, Lubascher J, Ibáñez P, Quera R, Kronberg U, Simian D, Flores L. Algoritmos de tratamiento de la colitis ulcerosa desde una experiencia local. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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56
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Naviglio S, Giuffrida P, Stocco G, Lenti MV, Ventura A, Corazza GR, Di Sabatino A. How to predict response to anti-tumour necrosis factor agents in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 2018; 12:797-810. [PMID: 29957083 DOI: 10.1080/17474124.2018.1494573] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anti-tumor necrosis factor (TNF) agents have changed the therapeutic approach to inflammatory bowel disease (IBD). However, a considerable proportion of patients either do not primarily respond or lose response to treatment. Despite the long-standing experience in the use of these drugs, still there is the need of identifying the possible predictors of efficacy. Areas covered: We critically review the current knowledge on predictors of response to anti-TNF therapy - both those available in clinical practice and those still under investigation. Multiple factors are involved in treatment success, including disease phenotype and severity, adherence to medications, and pharmacogenomic, pharmacokinetic, and immunologic factors. Literature search was conducted in PubMed using keywords 'inflammatory bowel disease,' 'Crohn's disease,' and 'ulcerative colitis,' matched with 'antitumor necrosis factor,' 'biologic therapy,' 'clinical response,' 'predictors,' and 'efficacy,' Relevant articles were selected for review. Expert commentary: While the role of several factors in clinical practice is clearly established, other investigational markers have been proposed, mostly in small studies, yet for many of them little external validation exists. Therapeutic drug monitoring is emerging as a pivotal strategy to guide decisions in clinical practice. In the near future, novel markers could improve our ability to direct treatment and personalize therapy.
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Affiliation(s)
- Samuele Naviglio
- a Institute for Maternal and Child Health IRCCS Burlo Garofolo , Trieste , Italy.,b Department of Medicine, Surgery, and Health Sciences , University of Trieste , Trieste , Italy
| | - Paolo Giuffrida
- c First Department of Internal Medicine, San Matteo Hospital Foundation , University of Pavia , Pavia , Italy
| | - Gabriele Stocco
- d Department of Life Science , University of Trieste , Trieste , Italy
| | - Marco Vincenzo Lenti
- c First Department of Internal Medicine, San Matteo Hospital Foundation , University of Pavia , Pavia , Italy
| | - Alessandro Ventura
- a Institute for Maternal and Child Health IRCCS Burlo Garofolo , Trieste , Italy.,b Department of Medicine, Surgery, and Health Sciences , University of Trieste , Trieste , Italy
| | - Gino Roberto Corazza
- c First Department of Internal Medicine, San Matteo Hospital Foundation , University of Pavia , Pavia , Italy
| | - Antonio Di Sabatino
- c First Department of Internal Medicine, San Matteo Hospital Foundation , University of Pavia , Pavia , Italy
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57
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Argollo MC, Kotze PG, Spinelli A, Gomes TNF, Danese S. The impact of biologics in surgical outcomes in ulcerative colitis. Best Pract Res Clin Gastroenterol 2018; 32-33:79-87. [PMID: 30060942 DOI: 10.1016/j.bpg.2018.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/22/2018] [Indexed: 01/31/2023]
Abstract
Ulcerative Colitis (UC) is an immune mediated condition characterized by inflammation of colonic mucosa, associated with progressive damage of the colon and possible complications, such as hemorrhage, perforation and cancer. It is strongly advocated a treat to target approach in patients with UC consisting in an early and aggressive inflammatory control. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia. Even though the first line biologic therapy targeting the tumor necrosis factor-alfa (TNF-α) is associated with improvement of the inflammation in some patients, others do not respond at first or lose response over time. Novel drugs targeting different inflammatory pathways have been studied in UC, however, it remains unclear whether surgical rates have been reduced in the biological era. Controversy also exists if biological agents impair surgical postoperative complication rates in UC. The aim of this review is to describe all relevant data available and briefly summarize the real impact of biologics in surgical outcomes in ulcerative colitis.
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Affiliation(s)
- Marjorie C Argollo
- Department of Gastroenterology, Universidade Federal de São Paulo, São Paulo, Brazil; IBD Advanced Visiting Fellowship, Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Paulo Gustavo Kotze
- IBD Outpatient, Catholic University of Paraná, Curitiba, Brazil; IBD Advanced Visiting Fellowship, University of Calgary, Calgary, Canada
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Tarcia N F Gomes
- Department of Gastroenterology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
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58
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Ribiere S, Leconte M, Chaussade S, Abitbol V. [Acute severe colitis]. Presse Med 2018; 47:312-319. [PMID: 29618409 DOI: 10.1016/j.lpm.2018.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022] Open
Abstract
Acute severe colitis is a potentially life-threatening medical and surgical emergency requiring hospitalization and intensive monitoring. The diagnosis of severe acute colitis is based on clinical and biological criteria. Colectomy should be discussed at each stage of management and is indicated immediately in case of complications. Thromboembolic prevention with low molecular weight heparin is essential in any patient with severe acute colitis. The first-line medical treatment is intravenous corticosteroid at a dose of 0.8mg/kg/day of prednisone equivalent. In case of failure, a second line of medical treatment can be attempted in the absence of complications. The two possible treatments are infliximab and ciclosporin.
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Affiliation(s)
- Sophie Ribiere
- AP-HP, hôpital Cochin, service de gastro-entérologie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - Mahaut Leconte
- AP-HP, hôpital Cochin, service de chirurgie digestive, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Stanislas Chaussade
- AP-HP, hôpital Cochin, service de gastro-entérologie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - Vered Abitbol
- AP-HP, hôpital Cochin, service de gastro-entérologie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France
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59
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Hanauer SB. Improving IBD Care: A Personalized Approach to Management. Gastroenterol Hepatol (N Y) 2018; 14:1-20. [PMID: 29991932 PMCID: PMC6018320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Stephen B Hanauer
- Clifford Joseph Barborka Professor of Medicine Medical Director, Digestive Health Center Northwestern University Feinberg School of Medicine Chicago, Illinois
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60
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Beswick L, Rosella O, Rosella G, Headon B, Sparrow MP, Gibson PR, van Langenberg DR. Exploration of Predictive Biomarkers of Early Infliximab Response in Acute Severe Colitis: A Prospective Pilot Study. J Crohns Colitis 2018; 12:289-297. [PMID: 29121178 DOI: 10.1093/ecco-jcc/jjx146] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/31/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The outcomes of acute severe ulcerative colitis [ASUC] appear to be dependent on early intervention with the first and/or further infliximab [IFX] doses, although parameters to guide decision-making remain uncertain. AIM To assess whether serum/faecal IFX levels and inflammatory biomarkers early after IFX dose can predict ASUC outcomes. METHODS This prospective pilot study consecutively recruited inpatients with steroid-refractory ASUC, who then received 1-3 IFX rescue doses [5 mg/kg per dose] at the discretion of the treating clinician. Serum IFX, C-reactive protein [CRP], albumin and faecal calprotectin [FC] concentrations were measured daily as an inpatient, and then 7, 14, 28 and 42 days post-first IFX. Faecal IFX was measured 1 day post-IFX. The primary end point was clinical remission (partial Mayo [PM] = 0) and CRP ≤3 mg/l at 6 weeks. Secondary end points were 12-week clinical remission or colectomy during follow-up. RESULTS Of 24 ASUC patients with a median follow-up of 28 months [range 13-44], 10 [42%] achieved remission at 6 weeks, 12 [50%] achieved 12-week remission, six [25%] had colectomy. In total, 97% received either two or three IFX doses. Post-first dose, receiver-operator curve-derived cutoffs of the area-under-curve [AUC, Days 4-7] concentrations for serum IFX, FC and PM scores each predicted the primary end point with 100% sensitivity, and predicted future colectomy with 89-94% sensitivity. In multivariate analyses, faecal IFX >1 µg/g (odds ratio [OR] 0.04 [0.2, 0.9]), PM AUCd1-3 < 20 (OR 20.2 [1.01, 404], each P < 0.05), FC AUCd1-3 < 10000 µg/ml [OR 13.6 [0.6, 294], trend only, p = 0.09) were each associated with clinical and CRP remission [6 weeks]. CONCLUSIONS In ASUC, post-first dose IFX, early assessment of serum/faecal IFX, calprotectin and PM scores can accurately predict future remission and colectomy, and thus potentially aid in decision-making, i.e. accelerated IFX dosing or surgical planning if/when needed.
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Affiliation(s)
- Lauren Beswick
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Australia.,Department of Gastroenterology, Eastern Health and Monash University, Melbourne, Australia
| | - Ourania Rosella
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Australia
| | - Gennaro Rosella
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Australia
| | - Belinda Headon
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Australia
| | - Miles P Sparrow
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Australia
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61
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Akintimehin AO, O'Neill RS, Ring C, Raftery T, Hussey S. Outcomes of a National Cohort of Children with Acute Severe Ulcerative Colitis. Front Pediatr 2018; 6:48. [PMID: 29568735 PMCID: PMC5853551 DOI: 10.3389/fped.2018.00048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/20/2018] [Indexed: 12/30/2022] Open
Abstract
AIM All Irish children with ulcerative colitis (UC) attend the National Centre for Paediatric Gastroenterology at Our Lady's Children's Hospital, Crumlin. The aim of this study was to determine the outcomes of children with acute severe ulcerative colitis (ASC) and the impact of infliximab on these outcomes following its introduction for this indication in 2011. METHODS A retrospective chart review of all patients admitted with ASC between January 1, 2009 and December 31, 2015 was undertaken. Patients were identified from the departmental database cross-referenced with the hospital inpatient enquiry system. Inpatients with a paediatric ulcerative colitis activity index (PUCAI) of ≥65 were included. Data collected included baseline demographic and laboratory data, concomitant treatments, PUCAI scores on days 3 and 5, second-line treatments, surgery, and discharge outcomes. Infliximab dose, frequency, and available therapeutic drug monitoring results were recorded, along with clinical response outcomes (remission, primary, and secondary loss of response). The cohort was sub-analysed to determine if there was any era effect pre- and post-introduction of infliximab (2009-2010 and 2011-2015, respectively). RESULTS Fifty-five patients (M:F = 1.4:1) were treated for acute severe colitis over the study period (8 in the pre-infliximab and 47 in the post-infliximab era) and 46/55 (86%) had steroid-refractory disease. Of these, 7/8 (88%) required colectomy in the pre-infliximab era, compared with 15/47 (36%) in the post-infliximab era. The remission rate with second-line infliximab was 61% at maximal follow-up. There were no identifiable factors that predicted likely success or failure of infliximab, including gender, CRP, day-3 and day-5 PUCAI scores. Of the 33 patients treated with infliximab, dose increase was required in 23/33 (70%); 21/33 (64%) received an accelerated dose schedule, and 9/33 (27%) eventually needed colectomy. Primary and secondary loss of response to infliximab was seen in one and nine patients, respectively. CONCLUSION This is the first population-based study of the outcomes of severe UC in Irish children, and suggests a higher burden of steroid-refractory disease compared with previous international studies. While infliximab treatment has led to reduction in colectomy rates, a significant proportion of patients lose therapeutic effect.
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Affiliation(s)
- Abisoye O Akintimehin
- National Centre for Paediatric Gastroenterology (NCPG), Our Lady's Children's Hospital, Crumlin (OLCHC), Dublin, Ireland
| | - Ríoghnach Sinead O'Neill
- National Centre for Paediatric Gastroenterology (NCPG), Our Lady's Children's Hospital, Crumlin (OLCHC), Dublin, Ireland
| | - Conor Ring
- National Centre for Paediatric Gastroenterology (NCPG), Our Lady's Children's Hospital, Crumlin (OLCHC), Dublin, Ireland
| | - Tara Raftery
- National Centre for Paediatric Gastroenterology (NCPG), Our Lady's Children's Hospital, Crumlin (OLCHC), Dublin, Ireland.,National Children's Research Centre, Crumlin, Ireland
| | - Séamus Hussey
- National Centre for Paediatric Gastroenterology (NCPG), Our Lady's Children's Hospital, Crumlin (OLCHC), Dublin, Ireland.,National Children's Research Centre, Crumlin, Ireland.,Royal College of Surgeons of Ireland, University College Dublin, Dublin, Ireland
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62
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Ding NS, Malietzis G, Hart AL. Editorial: anti-TNF therapy and myopenia in Crohn's disease-another step towards personalised medicine. Authors' reply. Aliment Pharmacol Ther 2018; 47:142-143. [PMID: 29226405 DOI: 10.1111/apt.14409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- N S Ding
- Inflammatory Bowel Disease Unit, St Mark's Hospital, Middlesex, Harrow, UK.,Department of Medicine and Surgery, Imperial College, London, UK.,University of Melbourne, Melbourne, Vic., Australia
| | - G Malietzis
- Inflammatory Bowel Disease Unit, St Mark's Hospital, Middlesex, Harrow, UK.,Department of Medicine and Surgery, Imperial College, London, UK
| | - A L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, Middlesex, Harrow, UK.,Department of Medicine and Surgery, Imperial College, London, UK
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63
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Wong U, Cross RK. Primary and secondary nonresponse to infliximab: mechanisms and countermeasures. Expert Opin Drug Metab Toxicol 2017; 13:1039-1046. [PMID: 28876147 DOI: 10.1080/17425255.2017.1377180] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Primary and secondary non-response to infliximab are common in patients with inflammatory bowel disease and remain a management challenge in clinical practice. Areas covered: This article describes the epidemiology, mechanisms and risk factors for primary and secondary nonresponse to infliximab in patients with inflammatory bowel disease. Data on proactive and reactive therapeutic drug monitoring are examined in this review. An algorithm for evaluation and management of non-response to infliximab is provided. Preventative measures are also discussed. Relevant articles were identified after a literature search using PubMed. Search terms included 'infliximab', 'loss of response', 'immunogenicity', and 'drug monitoring'. References of identified articles were also reviewed to identify additional references. Expert opinion: A common cause for primary and secondary non-response include inadequate dosing of infliximab; inadequate dosing can be identified through assessment of drug and anti-drug antibody levels. Therapeutic drug monitoring should be done in patients losing response to infliximab. Use of drug monitoring proactively is still under debate.
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Affiliation(s)
- Uni Wong
- a Department of Medicine, Division of Gastroenterology and Hepatology , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Raymond K Cross
- a Department of Medicine, Division of Gastroenterology and Hepatology , University of Maryland School of Medicine , Baltimore , MD , USA
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64
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Individualized Infliximab Treatment Guided by Patient-managed eHealth in Children and Adolescents with Inflammatory Bowel Disease. Inflamm Bowel Dis 2017; 23:1473-1482. [PMID: 28617758 DOI: 10.1097/mib.0000000000001170] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND To individualize timing of infliximab (IFX) treatment in children and adolescents with inflammatory bowel disease (IBD) using a patient-managed eHealth program. METHODS Patients with IBD, 10 to 17 years old, treated with IFX were prospectively included. Starting 4 weeks after their last infusion, patients reported a weekly symptom score and provided a stool sample for fecal calprotectin analysis. Based on symptom scores and fecal calprotectin results, the eHealth program calculated a total inflammation burden score that determined the timing of the next IFX infusion (4-12 wk after the previous infusion). Quality of Life was scored by IMPACT III. A control group was included to compare trough levels of IFX antibodies and concentrations and treatment intervals. Patients and their parents evaluated the eHealth program. RESULTS There were 29 patients with IBD in the eHealth group and 21 patients with IBD in the control group. During the control period, 94 infusions were provided in the eHealth group (mean interval 9.5 wk; SD 2.3) versus 105 infusions in the control group (mean interval 6.9 wk; SD 1.4). Treatment intervals were longer in the eHealth group (P < 0.001). Quality of Life did not change during the study. Appearance of IFX antibodies did not differ between the 2 groups. Eighty percent of patients reported increased disease control and 63% (86% of parents) reported an improved knowledge of the disease. CONCLUSIONS Self-managed, eHealth-individualized timing of IFX treatments, with treatment intervals of 4 to 12 weeks, was accompanied by no significant development of IFX antibodies. Patients reported better control and improved knowledge of their IBD.
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65
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Therapeutic Drug Monitoring During Induction of Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Disease: Defining a Therapeutic Drug Window. Inflamm Bowel Dis 2017; 23:1510-1515. [PMID: 28816757 DOI: 10.1097/mib.0000000000001231] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Anti-tumor necrosis factor (TNF) therapy has revolutionized the treatment of inflammatory bowel disease (IBD). However, up to 30% of patients with IBD show no clinical benefit and are defined as having a primary nonresponse. Primary nonresponse to a biologic can be attributed to either pharmacokinetic or pharmacodynamic issues, such as those involved in secondary loss of response. Pharmacokinetic issues are linked to undetectable or subtherapeutic drug concentrations because of either an accelerated non-immune-mediated clearance or immunogenicity and the development of antidrug antibodies, whereas pharmacodynamic issues are likely related to "non-TNF driven" disease. Therapeutic drug monitoring (TDM), defined as the evaluation of drug concentrations and antidrug antibodies, has been proven effective for optimizing anti-TNF therapy in IBD. Nevertheless, most of the data for TDM relate to patients losing response during maintenance therapy, whereas much less is known about the therapeutic drug window and use of TDM during anti-TNF induction therapy. Recent exposure-response relationship studies, though, demonstrate that high serum anti-TNF drug concentrations during and early after induction therapy are associated with favorable therapeutic outcomes in IBD. This suggests that early optimization of anti-TNF therapy may prevent some of the primary nonresponse related to pharmacokinetic issues (low drug concentrations) and lead to better short- and long-term outcomes. This review will focus on the role of TDM during the induction phase of anti-TNF therapy.
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66
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Jairath V, Vande Casteele N, Hindryckx P. Letter: dose optimising infliximab in acute severe ulcerative colitis - authors' reply. Aliment Pharmacol Ther 2017; 45:1170-1171. [PMID: 28326588 DOI: 10.1111/apt.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- V Jairath
- Departments of Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Robarts Clinical Trials Inc., London, Ontario, Canada
| | - N Vande Casteele
- Robarts Clinical Trials Inc., London, Ontario, Canada.,Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - P Hindryckx
- Robarts Clinical Trials Inc., London, Ontario, Canada.,Department of Gastroenterology, University hospital of Ghent, Ghent, Belgium
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67
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Choy MC, De Cruz P. Letter: dose optimising infliximab in acute severe ulcerative colitis. Aliment Pharmacol Ther 2017; 45:1169-1170. [PMID: 28326583 DOI: 10.1111/apt.13980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M C Choy
- Department of Gastroenterology, Austin Health, Melbourne, Vic., Australia.,Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Vic., Australia
| | - P De Cruz
- Department of Gastroenterology, Austin Health, Melbourne, Vic., Australia.,Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Vic., Australia
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