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James JP, Nielsen BS, Langholz E, Malham M, Høgdall E, Riis LB. Estimating tissue-specific TNF mRNA levels prior to anti-TNFα treatment may support therapeutic optimisation in IBD patients. Scand J Gastroenterol 2023; 58:1237-1245. [PMID: 37246424 DOI: 10.1080/00365521.2023.2217313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS Tumour necrosis factor-α (TNF) antagonists have improved the management of inflammatory bowel disease (IBD), however, their usage and administration persist to be suboptimal. Here, we examined the relationship between tissue-specific TNF mRNA expression in mucosal biopsies from IBD patients and anti-TNF treatment response. METHODS Archived tissue samples from patients with luminal IBD that had all been or were in treatment with anti-TNF were included (18 adults and 24 paediatric patients). Patients were stratified into three groups according to anti-TNF response: responders, primary non-responders (PNR) and secondary loss of response (SLOR). TNF mRNA was detected using RNAscope in situ hybridisation (ISH) and the expression was quantified using image analysis. RESULTS The ISH analysis showed varying occurrence of TNF mRNA positive cells located in lamina propria and often with increased density in lymphoid follicles (LF). Consequently, expression estimates were obtained in whole tissue areas with and without LF. Significantly higher TNF mRNA expression levels were measured in adults compared to paediatric patients in both the analyses with and without LF (p = .015 and p = .016, respectively). Considering the relation to response, the adult and paediatric patients were evaluated separately. In adults, the TNF expression estimates were higher in PNRs compared to responders with and without LF (p = .017 and p = .024, respectively). CONCLUSION Our data indicate that adult PNR have significantly higher TNF mRNA levels than responders. This suggests that higher anti-TNF dose may be considered for IBD patients with high TNF mRNA expression estimates from the start of treatment.
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Affiliation(s)
- Jaslin P James
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Ebbe Langholz
- Department of Gastroenterology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Malham
- The Pediatric Department, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Estrid Høgdall
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Buhl Riis
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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2
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Ning L, Ye N, Ye B, Miao Z, Cao T, Lu W, Xu D, Tan C, Xu Y, Yan J. Qingre Xingyu recipe exerts inhibiting effects on ulcerative colitis development by inhibiting TNFα/NLRP3/Caspase-1/IL-1β pathway and macrophage M1 polarization. Cell Death Discov 2023; 9:84. [PMID: 36890151 PMCID: PMC9995513 DOI: 10.1038/s41420-023-01361-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/10/2023] Open
Abstract
As a chronic inflammatory bowel disease, ulcerative colitis (UC) imposes a significant burden on public healthcare worldwide due to its increasing morbidity. Chinese medicines are regarded as potent therapeutic agents for UC treatment with minimal side effects. In the present study, we sought to determine the novel role of a traditional medicine Qingre Xingyu (QRXY) recipe in the development of UC and aimed to contribute to the currently available knowledge about UC by exploring the downstream mechanism of QRXY recipe in UC. Mouse models of UC were established by injections with dextran sulphate sodium (DSS), where the expression of tumor necrosis factor-alpha (TNFα), NLR family pyrin domain containing 3 (NLRP3), and interleukin-1β (IL-1β) was determined followed by an analysis of their interactions. The DSS-treated NLRP3 knockout (-/-) Caco-2 cell model was successfully constructed. The in vitro and in vivo effects of the QRXY recipe on UC were investigated with the determination of disease activity index (DAI), histopathological scores, transepithelial electrical resistance, FITC-dextran, as well as cell proliferation and apoptosis. In vivo and in vitro experiments indicated that the QRXY recipe reduced the degree of intestinal mucosal injury of UC mice and functional damage of DSS-induced Caco-2 cells by inhibition of the TNFα/NLRP3/caspase-1/IL-1β pathway and M1 polarization of macrophages, and TNFα overexpression or NLRP3 knockdown could counterweigh the therapeutic effects of QRXY recipe. To conclude, our study elicited that QRXY inhibited the expression of TNFα and inactivated the NLRP3/Caspase-1/IL-1β pathway, thereby alleviating intestinal mucosal injury and relieving UC in mice.
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Affiliation(s)
- Liqin Ning
- Chinese Medicine Master Studio, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, P. R. China
| | - Ningyuan Ye
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, 210023, P. R. China
| | - Bai Ye
- Department of Gastroenterology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, P. R. China
| | - Zhiwei Miao
- Department of Gastroenterology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215600, P. R. China
| | - Tingting Cao
- Department of Gastroenterology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, P. R. China
| | - Weimin Lu
- Department of Internal Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, P. R. China
| | - Danhua Xu
- Chinese Medicine Master Studio, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, P. R. China
| | - Chang Tan
- Chinese Medicine Master Studio, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, P. R. China
| | - Yi Xu
- Department of Gastroenterology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, P. R. China.
| | - Jing Yan
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, 210023, P. R. China.
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3
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Angelini G, Castagneto-Gissey L, Salinari S, Bertuzzi A, Anello D, Pradhan M, Zschätzsch M, Ritter P, Le Roux CW, Rubino F, Basso N, Casella G, Bornstein SR, Tremaroli V, Mingrone G. Upper gut heat shock proteins HSP70 and GRP78 promote insulin resistance, hyperglycemia, and non-alcoholic steatohepatitis. Nat Commun 2022; 13:7715. [PMID: 36513656 PMCID: PMC9748124 DOI: 10.1038/s41467-022-35310-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
A high-fat diet increases the risk of insulin resistance, type-2 diabetes, and non-alcoholic steato-hepatitis. Here we identified two heat-shock proteins, Heat-Shock-Protein70 and Glucose-Regulated Protein78, which are increased in the jejunum of rats on a high-fat diet. We demonstrated a causal link between these proteins and hepatic and whole-body insulin-resistance, as well as the metabolic response to bariatric/metabolic surgery. Long-term continuous infusion of Heat-Shock-Protein70 and Glucose-Regulated Protein78 caused insulin-resistance, hyperglycemia, and non-alcoholic steato-hepatitis in rats on a chow diet, while in rats on a high-fat diet continuous infusion of monoclonal antibodies reversed these phenotypes, mimicking metabolic surgery. Infusion of these proteins or their antibodies was also associated with shifts in fecal microbiota composition. Serum levels of Heat-Shock-Protein70 and Glucose-Regulated Protein78were elevated in patients with non-alcoholic steato-hepatitis, but decreased following metabolic surgery. Understanding the intestinal regulation of metabolism may provide options to reverse metabolic diseases.
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Affiliation(s)
- Giulia Angelini
- grid.8142.f0000 0001 0941 3192Università Cattolica del Sacro Cuore, Rome, Italy ,grid.414603.4Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Serenella Salinari
- grid.7841.aDepartment of Computer, Control, and Management Engineering “Antonio Ruberti”, University of Rome “Sapienza”, Rome, Italy
| | - Alessandro Bertuzzi
- grid.419461.f0000 0004 1760 8338CNR-Institute of Systems Analysis and Computer Science (IASI), Rome, Italy
| | - Danila Anello
- grid.8142.f0000 0001 0941 3192Università Cattolica del Sacro Cuore, Rome, Italy
| | - Meenakshi Pradhan
- grid.8761.80000 0000 9919 9582Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Marlen Zschätzsch
- grid.4488.00000 0001 2111 7257Institute of Natural Materials Technology, Faculty of Mechanical Science and Engineering, Technischen Universität Dresden, Dresden, Germany ,Biotopa gGmbH, Dresden, Germany
| | | | - Carel W. Le Roux
- grid.7886.10000 0001 0768 2743Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- grid.46699.340000 0004 0391 9020Bariatric and Metabolic Surgery; King’s College Hospital, London, UK
| | - Nicola Basso
- grid.7841.aDepartment of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Casella
- grid.7841.aDepartment of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefan R. Bornstein
- grid.412282.f0000 0001 1091 2917Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany ,grid.13097.3c0000 0001 2322 6764Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, UK
| | - Valentina Tremaroli
- grid.8761.80000 0000 9919 9582Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Geltrude Mingrone
- grid.8142.f0000 0001 0941 3192Università Cattolica del Sacro Cuore, Rome, Italy ,grid.414603.4Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy ,grid.13097.3c0000 0001 2322 6764Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, UK
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4
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Ulcerative Colitis and Acute Severe Ulcerative Colitis Patients Are Overlooked in Infliximab Population Pharmacokinetic Models: Results from a Comprehensive Review. Pharmaceutics 2022; 14:pharmaceutics14102095. [PMID: 36297530 PMCID: PMC9610912 DOI: 10.3390/pharmaceutics14102095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Ulcerative colitis (UC) is part of the inflammatory bowels diseases, and moderate to severe UC patients can be treated with anti-tumour necrosis α monoclonal antibodies, including infliximab (IFX). Even though treatment of UC patients by IFX has been in place for over a decade, many gaps in modelling of IFX PK in this population remain. This is even more true for acute severe UC (ASUC) patients for which early prediction of IFX pharmacokinetic (PK) could highly improve treatment outcome. Thus, this review aims to compile and analyse published population PK models of IFX in UC and ASUC patients, and to assess the current knowledge on disease activity impact on IFX PK. For this, a semi-systematic literature search was conducted, from which 26 publications including a population PK model analysis of UC patients receiving IFX therapy were selected. Amongst those, only four developed a model specifically for UC patients, and only three populations included severe UC patients. Investigations of disease activity impact on PK were reported in only 4 of the 14 models selected. In addition, the lack of reported model codes and assessment of predictive performance make the use of published models in a clinical setting challenging. Thus, more comprehensive investigation of PK in UC and ASUC is needed as well as more adequate reports on developed models and their evaluation in order to apply them in a clinical setting.
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Ternant D, Le Tilly O, Picon L, Moussata D, Passot C, Bejan-Angoulvant T, Desvignes C, Mulleman D, Goupille P, Paintaud G. Infliximab Efficacy May Be Linked to Full TNF-α Blockade in Peripheral Compartment-A Double Central-Peripheral Target-Mediated Drug Disposition (TMDD) Model. Pharmaceutics 2021; 13:pharmaceutics13111821. [PMID: 34834236 PMCID: PMC8623740 DOI: 10.3390/pharmaceutics13111821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
Infliximab is an anti-TNF-α monoclonal antibody approved in chronic inflammatory bowel diseases (IBD). This study aimed at providing an in-depth description of infliximab target-mediated pharmacokinetics in 133 IBD patients treated with 5 mg/kg infliximab at weeks 0, 2, 14, and 22. A two-compartment model with double target-mediated drug disposition (TMDD) in both central and peripheral compartments was developed, using a rich database of 26 ankylosing spondylitis patients as a reference for linear elimination kinetics. Population approach and quasi-steady-state (QSS) approximation were used. Concentration-time data were satisfactorily described using the double-TMDD model. Target-mediated parameters of central and peripheral compartments were respectively baseline TNF concentrations (RC0 = 3.3 nM and RP0 = 0.46 nM), steady-stated dissociation rates (KCSS = 15.4 nM and KPSS = 0.49 nM), and first-order elimination rates of complexes (kCint = 0.17 day−1 and kPint = 0.0079 day−1). This model showed slower turnover of targets and infliximab-TNF complex elimination rate in peripheral compartment than in central compartment. This study allowed a better understanding of the multi-scale target-mediated pharmacokinetics of infliximab. This model could be useful to improve model-based therapeutic drug monitoring of infliximab in IBD patients.
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Affiliation(s)
- David Ternant
- EA 4245 “Transplantation, Immunology, Inflammation”, Université de Tours, 37044 Tours, France; (O.L.T.); (D.M.); (T.B.-A.); (C.D.); (G.P.)
- Department of Clinical Pharmacology, CHRU de Tours, 37044 Tour, France
- Correspondence:
| | - Olivier Le Tilly
- EA 4245 “Transplantation, Immunology, Inflammation”, Université de Tours, 37044 Tours, France; (O.L.T.); (D.M.); (T.B.-A.); (C.D.); (G.P.)
- Department of Clinical Pharmacology, CHRU de Tours, 37044 Tour, France
| | - Laurence Picon
- Department of Gastroenterology, CHRU de Tours, 37044 Tour, France;
| | - Driffa Moussata
- EA 4245 “Transplantation, Immunology, Inflammation”, Université de Tours, 37044 Tours, France; (O.L.T.); (D.M.); (T.B.-A.); (C.D.); (G.P.)
- Department of Gastroenterology, CHRU de Tours, 37044 Tour, France;
| | - Christophe Passot
- Département de Biopathologie, Institut de Cancérologie de l’Ouest, 49055 Angers, France;
| | - Theodora Bejan-Angoulvant
- EA 4245 “Transplantation, Immunology, Inflammation”, Université de Tours, 37044 Tours, France; (O.L.T.); (D.M.); (T.B.-A.); (C.D.); (G.P.)
- Department of Clinical Pharmacology, CHRU de Tours, 37044 Tour, France
| | - Céline Desvignes
- EA 4245 “Transplantation, Immunology, Inflammation”, Université de Tours, 37044 Tours, France; (O.L.T.); (D.M.); (T.B.-A.); (C.D.); (G.P.)
- Department of Clinical Pharmacology, CHRU de Tours, 37044 Tour, France
| | - Denis Mulleman
- EA 7501 “Groupe Innovation et Ciblage Cellulaire”, Université de Tours, 37044 Tour, France;
- Department of Rheumatology, CHRU de Tours, 37044 Tour, France;
| | | | - Gilles Paintaud
- EA 4245 “Transplantation, Immunology, Inflammation”, Université de Tours, 37044 Tours, France; (O.L.T.); (D.M.); (T.B.-A.); (C.D.); (G.P.)
- Department of Clinical Pharmacology, CHRU de Tours, 37044 Tour, France
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6
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Aguiar Zdovc J, Hanžel J, Kurent T, Sever N, Koželj M, Smrekar N, Novak G, Štabuc B, Dreesen E, Thomas D, Vovk T, Ostanek B, Drobne D, Grabnar I. Ustekinumab Dosing Individualization in Crohn's Disease Guided by a Population Pharmacokinetic-Pharmacodynamic Model. Pharmaceutics 2021; 13:pharmaceutics13101587. [PMID: 34683880 PMCID: PMC8538292 DOI: 10.3390/pharmaceutics13101587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/22/2022] Open
Abstract
Ustekinumab is a monoclonal antibody used in Crohn’s disease (CD). Dose optimization in case of non-response and the role of pharmacokinetic–pharmacodynamic (PK-PD) monitoring remain unresolved dilemmas in clinical practice. We aimed to develop a population PK-PD model for ustekinumab in CD and simulate efficacy of alternative dosing regimens. We included 57 patients and recorded their characteristics during 32 weeks after starting with ustekinumab therapy. Serum ustekinumab concentration was prospectively measured and fecal calprotectin (FC) concentration was used to monitor the disease activity. Ustekinumab PK-PD was described by a two-compartment target-mediated drug disposition model linked to an indirect response model. Lower fat-free mass, higher serum albumin, previous non-exposure to biologics, FCGR3A-158 V/V variant and lower C-reactive protein were associated with higher ustekinumab exposure. Model-based simulation suggested that 41.9% of patients receiving standard dosing achieve biochemical remission at week 32. In patients not achieving remission with standard dosing at week 16, transition to 4-weekly subcutaneous maintenance dosing with or without intravenous reinduction resulted in comparably higher remission rates at week 32 (51.1% vs. 49.2%, respectively). Our findings could be used to guide stratified ustekinumab treatment in CD, particularly in patients with unfavorable characteristics, who might benefit from early transition to 4-weekly maintenance dosing.
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Affiliation(s)
- Jurij Aguiar Zdovc
- Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (J.A.Z.); (T.V.)
| | - Jurij Hanžel
- Department of Gastroenterology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (J.H.); (T.K.); (N.S.); (M.K.); (N.S.); (G.N.); (B.Š.); (D.D.)
- Department of Internal Medicine, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Tina Kurent
- Department of Gastroenterology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (J.H.); (T.K.); (N.S.); (M.K.); (N.S.); (G.N.); (B.Š.); (D.D.)
| | - Nejc Sever
- Department of Gastroenterology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (J.H.); (T.K.); (N.S.); (M.K.); (N.S.); (G.N.); (B.Š.); (D.D.)
| | - Matic Koželj
- Department of Gastroenterology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (J.H.); (T.K.); (N.S.); (M.K.); (N.S.); (G.N.); (B.Š.); (D.D.)
| | - Nataša Smrekar
- Department of Gastroenterology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (J.H.); (T.K.); (N.S.); (M.K.); (N.S.); (G.N.); (B.Š.); (D.D.)
| | - Gregor Novak
- Department of Gastroenterology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (J.H.); (T.K.); (N.S.); (M.K.); (N.S.); (G.N.); (B.Š.); (D.D.)
| | - Borut Štabuc
- Department of Gastroenterology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (J.H.); (T.K.); (N.S.); (M.K.); (N.S.); (G.N.); (B.Š.); (D.D.)
- Department of Internal Medicine, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Erwin Dreesen
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (E.D.); (D.T.)
- Department of Pharmacy, Uppsala University, 751 23 Uppsala, Sweden
| | - Debby Thomas
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (E.D.); (D.T.)
| | - Tomaž Vovk
- Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (J.A.Z.); (T.V.)
| | - Barbara Ostanek
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (J.H.); (T.K.); (N.S.); (M.K.); (N.S.); (G.N.); (B.Š.); (D.D.)
- Department of Internal Medicine, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Iztok Grabnar
- Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (J.A.Z.); (T.V.)
- Correspondence: ; Tel.: +386-1-4769-543
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7
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Infliximab Treatment Does Not Lead to Full TNF-α Inhibition: A Target-Mediated Drug Disposition Model. Clin Pharmacokinet 2021; 61:143-154. [PMID: 34351609 DOI: 10.1007/s40262-021-01057-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Infliximab, an anti-tumour necrosis factor (TNF)-α monoclonal antibody, has been approved in chronic inflammatory disease, including rheumatoid arthritis, Crohn's disease and ankylosing spondylitis. This study aimed to investigate and characterise target-mediated drug disposition of infliximab and antigen mass turnover during infliximab treatment. METHODS In this retrospective cohort of 186 patients treated with infliximab for rheumatoid arthritis, Crohn's disease or ankylosing spondylitis, trough infliximab concentrations were determined from samples collected between weeks 0 and 22 after treatment initiation. Target-mediated pharmacokinetics of infliximab was described using target-mediated drug disposition modelling. Target-mediated elimination parameters were determined for rheumatoid arthritis and Crohn's disease, assuming ankylosing spondylitis with no target-mediated elimination. RESULTS The quasi-equilibrium approximation of a target-mediated drug disposition model allowed a satisfactory description of infliximab concentration-time data. Estimated baseline TNF-α amounts were similar in Crohn's disease and rheumatoid arthritis (R0 = 0.39 vs 0.46 nM, respectively), but infliximab-TNF complex elimination was slower in Crohn's disease than in rheumatoid arthritis (kint = 0.024 vs 0.061 day-1, respectively). Terminal elimination half-lives were 13.5, 21.5 and 16.5 days for rheumatoid arthritis, Crohn's disease and ankylosing spondylitis, respectively. Estimated amounts of free target were close to baseline values before the next infusion suggesting that TNF-α inhibition may not be sustained over the entire dose interval. CONCLUSIONS The present study is the first to quantify the influence of target antigen dynamics on infliximab pharmacokinetics. Target-mediated elimination of infliximab may be complex, involving a multi-scale turnover of TNF-α, especially in patients with Crohn's disease. Additional clinical studies are warranted to further evaluate and fine-tune dosing approaches to ensure sustained TNF-α inhibition.
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8
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Le Tilly O, Bejan-Angoulvant T, Paintaud G, Ternant D. Letter to Dreesen et al. on their article "Modelling of the Relationship Between Infliximab Exposure, Faecal Calprotectin, and Endoscopic Remission in Patients With Crohn's Disease"-A comprehensive review of infliximab population pharmacokinetic modelling publications. Br J Clin Pharmacol 2020; 87:1594-1595. [PMID: 33269471 DOI: 10.1111/bcp.14554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Olivier Le Tilly
- Université de Tours, Tours, France.,Department of Medical Pharmacology, CHRU de Tours, Tours, France
| | - Theodora Bejan-Angoulvant
- Université de Tours, Tours, France.,Department of Medical Pharmacology, CHRU de Tours, Tours, France
| | - Gilles Paintaud
- Université de Tours, Tours, France.,Department of Medical Pharmacology, CHRU de Tours, Tours, France
| | - David Ternant
- Université de Tours, Tours, France.,Department of Medical Pharmacology, CHRU de Tours, Tours, France
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