Relationship between serum infliximab trough levels and endoscopic activities in patients with Crohn’s disease under scheduled maintenance treatment
- First Online:
- 950 Downloads
Background and aims
Few data are available to support the clinical relevance of infliximab (IFX) trough levels for prediction of endoscopic disease activity in Crohn’s disease (CD). This study evaluated the endoscopic disease activities in relation to clinical outcome using several laboratory markers including serum IFX trough levels in patients with CD undergoing scheduled IFX maintenance treatment.
Materials and methods
A total of 78 sessions of endoscopy were performed on 45 patients with CD. Endoscopic activity was assessed using the modified Rutgeerts scoring system. IFX trough levels and anti-IFX antibodies (ATIs) were determined by immunoassays.
Endoscopic activity negatively correlated with serum IFX trough levels (Spearman’s rank correlation coefficient (ρ) = −0.54, P < 0.0001) and serum albumin levels (ρ = −0.46, P < 0.0001), and positively correlated with CRP (C-reactive protein) levels (ρ = 0.55, P < 0.0001), ESR (erythrocyte sedimentation rate) (ρ = 0.47, P < 0.0001) and fecal calprotectin levels. IFX trough levels and serum albumin levels were significantly elevated in the mucosal healing (MH) group, but ATIs, CRP, ESR and fecal calprotectin levels were significantly elevated in the nonmucosal healing group. Receiver operation curve revealed that the optimal cutoff value of IFX trough levels for identifying normal laboratory markers was 0.6 μg/ml for CRP, 1.0 μg/ml for serum albumin and 1.1 μg/ml for fecal calprotectin. Identification of mucosal healing needed a higher cutoff value of 4.0 μg/ml. Thiopurine treatment did not affect IFX trough and ATI levels.
Mucosal healing requires higher IFX trough levels, compared to those to achieve normalization of routine clinical markers.
KeywordsAnti-infliximab antibodies Mucosal healing Receiver operation curve
- 9.D’Haens GR, Panaccione R, Higgins PD, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn’s and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response? Am J Gastroenterol. 2011;106:199–212 (quiz 213).Google Scholar
- 15.Bortlik M, Duricova D, Malickova K, et al. Infliximab trough levels may predict sustained response to infliximab in patients with Crohn’s disease. J Crohns Colitis. 2012. doi:10.1016/j.crohns.2012.10.019.
- 21.Nanda KS, Cheifetz AS, Moss AC. Impact of antibodies to infliximab on clinical outcomes and serum infliximab levels in patients with inflammatory bowel disease (IBD): a meta-analysis. Am J Gastroenterol. 2013;108:40–7.Google Scholar
- 23.Baert F, Moortgat L, Van Assche G, et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn’s disease. Gastroenterology. 2010;138:463–8 (quiz e410–461).Google Scholar
- 26.Mary JY, Modigliani R. Development and validation of an endoscopic index of the severity for Crohn’s disease: a prospective multicentre study. Groupe d’Etudes Therapeutiques des Affections Inflammatoires du Tube Digestif (GETAID). Gut. 1989;30:983–9.Google Scholar
- 28.af Bjorkesten CG, Nieminen U, Turunen U, et al. Endoscopic monitoring of infliximab therapy in Crohn’s disease. Inflamm Bowel Dis. 2011;17:947–53.Google Scholar
- 31.Rutgeerts P, Diamond RH, Bala M, et al. Scheduled maintenance treatment with infliximab is superior to episodic treatment for the healing of mucosal ulceration associated with Crohn’s disease. Gastrointest Endosc. 2006;63:433–42 (quiz 464).Google Scholar