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Nones RB, Miranda EF, Marçal GDN, Baraúna FDSB, Loures MR, Senger PC, Magro DO, Kotze PG. Infliximab serum concentrations in luminal Crohn's disease and its relationship with disease activity: A multicentric cross-sectional study. GASTROENTEROLOGIA Y HEPATOLOGIA 2023:S0210-5705(23)00505-8. [PMID: 38160706 DOI: 10.1016/j.gastrohep.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES In Latin America, experience with monitoring serum Infliximab (IFX) concentrations is scarce. Our study aimed to compare IFX serum concentrations between patients with active disease or in remission. PATIENTS AND METHODS A cross-sectional study was performed in patients with luminal Crohn's disease (CD) during maintenance treatment with IFX. Patients were classified as in remission or disease activity according to clinical scores and endoscopic, radiological, and laboratory markers. A comparison of IFX trough levels between the two groups was performed. RESULTS 80 CD patients were included [41 (51%) in remission and 39 (49%) with active disease]. In the analysis of general disease activity, the median serum levels of IFX in patients with remission and with active CD were 5.63 [0.03-14.40] vs. 3.84 [0.03-14.40] (p=0.287). Furthermore, there was no difference in serum IFX concentrations in endoscopic, radiological, and laboratory activities. Only in the clinical evaluation there was a significant difference in the median serum IFX levels between patients in remission and disease activity, 5.63 [0.03-14.40] vs. 2.14 [0.32-10.54] (p=0.042). CONCLUSIONS IFX serum concentrations during maintenance treatment were similar in patients with luminal CD in remission and general, endoscopic, radiological, and laboratory disease activity. Patients with clinically active disease had lower IFX concentrations than patients in remission.
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Affiliation(s)
| | - Eron Fabio Miranda
- Colorectal Surgery Unit, Pontifícia Universidade Católica do Paraná, PUCPR, Curitiba, Brazil
| | - Gustavo de Nardi Marçal
- Colorectal Surgery Unit, Pontifícia Universidade Católica do Paraná, PUCPR, Curitiba, Brazil
| | | | | | | | | | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Pontifícia Universidade Católica do Paraná, PUCPR, Curitiba, Brazil
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2
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Li X, Zhong Y, Yuan C, Lin J, Shen X, Guo M, Lu B, Meng J, Wang Y, Zhang N, Luo Z, Hu G, Mao R, Chen M, Sun C, Li Z, Cao Q, Chen B, Chen Z, Huang B, Feng S. Identifying patients with Crohn's disease at high risk of primary nonresponse to infliximab using a radiomic‐clinical model. INT J INTELL SYST 2022. [DOI: 10.1002/int.23066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Xuehua Li
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Yingkui Zhong
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
- Department of Gastroenterology, The Sixth Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Chenglang Yuan
- Medical AI Lab, School of Biomedical Engineering, Health Science Center Shenzhen University Shenzhen China
| | - Jinjiang Lin
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Xiaodi Shen
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Minyi Guo
- Department of Radiology, The Sixth Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Baolan Lu
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Jixin Meng
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Yangdi Wang
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Naiwen Zhang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center Shenzhen University Shenzhen China
| | - Zixin Luo
- Medical AI Lab, School of Biomedical Engineering, Health Science Center Shenzhen University Shenzhen China
| | - Guimeng Hu
- Medical AI Lab, School of Biomedical Engineering, Health Science Center Shenzhen University Shenzhen China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Canhui Sun
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Ziping Li
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Qing‐hua Cao
- Department of Pathology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Baili Chen
- Department of Gastroenterology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Zhihui Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center Shenzhen University Shenzhen China
| | - Shi‐Ting Feng
- Department of Radiology, The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
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3
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Mattoo VY, Basnayake C, Connell WR, Ding N, Kamm MA, Lust M, Niewiadomski O, Thompson A, Wright EK. Systematic review: efficacy of escalated maintenance anti-tumour necrosis factor therapy in Crohn's disease. Aliment Pharmacol Ther 2021; 54:249-266. [PMID: 34153124 DOI: 10.1111/apt.16479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/12/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Loss of response to anti-TNF agents is a common clinical problem. Dose escalation may be effective for reestablishing clinical response in Crohn's disease (CD). AIMS To perform a systematic review assessing the efficacy of escalated maintenance anti-TNF therapy in CD. METHODS EMBASE, MEDLINE, Web of Science, and CENTRAL databases were searched for English language publications through to April 25, 2021. Full-text articles evaluating escalated maintenance treatment (infliximab or adalimumab) in adult CD patients were included. RESULTS A total of 4733 records were identified, and 68 articles met eligibility criteria. Rates of clinical response (33%-100%) and remission (15%-83%) after empiric dose escalation for loss of response to standard anti-TNF therapy were high but varied across studies. Dose intensification strategies (doubling the dose versus shortening the therapeutic interval) were similarly efficacious. Dose-escalated patients tended to have higher serum drug levels compared to those on standard dosing. An exposure-response relationship following dose escalation was found in a number of observational studies. Randomised controlled trials comparing therapeutic drug monitoring (TDM) to empiric treatment intensification have failed to reach their primary end-points. Strategies including Bayesian dashboard-dosing and early treatment escalation targeting biomarker normalisation were found to be associated with improved long-term outcomes. CONCLUSIONS Empiric escalation of maintenance anti-TNF therapy can recapture clinical response in a majority of patients with secondary loss of response to standard maintenance doses. Proactive optimisation of maintenance dosing might prolong time to loss of response in some patients.
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Affiliation(s)
- Vandita Y Mattoo
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Chamara Basnayake
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - William R Connell
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Nik Ding
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Michael A Kamm
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Alexander Thompson
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Emily K Wright
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
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4
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Grisic AM, Eser A, Huisinga W, Reinisch W, Kloft C. Quantitative relationship between infliximab exposure and inhibition of C-reactive protein synthesis to support inflammatory bowel disease management. Br J Clin Pharmacol 2020; 87:2374-2384. [PMID: 33184852 DOI: 10.1111/bcp.14648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/13/2020] [Accepted: 11/06/2020] [Indexed: 01/11/2023] Open
Abstract
AIM Quantitative and kinetic insights into the drug exposure-disease response relationship might enhance our knowledge on loss of response and support more effective monitoring of inflammatory activity by biomarkers in patients with inflammatory bowel disease (IBD) treated with infliximab (IFX). This study aimed to derive recommendations for dose adjustment and treatment optimisation based on mechanistic characterisation of the relationship between IFX serum concentration and C-reactive protein (CRP) concentration. METHODS Data from an investigator-initiated trial included 121 patients with IBD during IFX maintenance treatment. Serum concentrations of IFX, antidrug antibodies (ADA), CRP, and disease-related covariates were determined at the mid-term and end of a dosing interval. Data were analysed using a pharmacometric nonlinear mixed-effects modelling approach. An IFX exposure-CRP model was generated and applied to evaluate dosing regimens to achieve CRP remission. RESULTS The generated quantitative model showed that IFX has the potential to inhibit up to 72% (9% relative standard error [RSE]) of CRP synthesis in a patient. IFX concentration leading to 90% of the maximum CRP synthesis inhibition was 18.4 μg/mL (43% RSE). Presence of ADA was the most influential factor on IFX exposure. With standard dosing strategy, ≥55% of ADA+ patients experienced CRP nonremission. Shortening the dosing interval and co-therapy with immunomodulators were found to be the most beneficial strategies to maintain CRP remission. CONCLUSIONS With the generated model we could for the first time establish a robust relationship between IFX exposure and CRP synthesis inhibition, which could be utilised for treatment optimisation in IBD patients.
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Affiliation(s)
- Ana-Marija Grisic
- Department of Clinical Pharmacy & Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Germany.,Graduate Research Training Program PharMetrX, Germany
| | - Alexander Eser
- Department for Gastroenterology and Hepatology, Medical University of Vienna, Austria
| | | | - Walter Reinisch
- Department for Gastroenterology and Hepatology, Medical University of Vienna, Austria
| | - Charlotte Kloft
- Department of Clinical Pharmacy & Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Germany
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