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Pharmacokinetics of Infliximab and Reduction of Treatment for Inflammatory Bowel Diseases

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Abstract

Local or national policy, patients’ preferences, safety and/or economic concerns, or reimbursement issues may dictate stopping drug in inflammatory bowel diseases (IBD) patients. Sustained deep remission is an important predictor of a better outcome after anti-tumor necrosis (TNF) factor therapy discontinuation, including infliximab (IFX) in IBD patients, but this is not sufficient to prevent future relapse in these patients. In IBD patients under combotherapy, trough level of infliximab (TRI) could be helpful to choose stopping one of the two drugs. In patients on IFX monotherapy, TRI could help to decide reduction of drug dosing, particularly in IBD patients with supratherapeutic trough levels. Incidental findings of undetectable TRI in patients with deep remission may identify a subset of patients who may be considered for IFX cessation. Controlled trials further assessing this issue are eagerly awaited. Pending these trials, clear international recommendations for discontinuing anti-TNF therapy are needed.

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Abbreviations

ATI:

Antibodies against infliximab

AZA:

Azathioprine

CD:

Crohn’s disease

CRP:

C-reactive protein

IBD:

Inflammatory bowel disease

IFX:

Infliximab

IMM:

Immunomodulator

TCM:

Therapeutic concentration monitoring

TRI:

Trough level of infliximab

UC:

Ulcerative colitis

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Authors and Affiliations

  1. CIC Inserm et Service d’Hépato-gastroentérologie, Hôpital Universitaire de Saint Etienne, Université Jean Monnet, Avenue Albert Raimond, 4227, Saint Priest en Jarez, France

    Nicolas Williet & Xavier Roblin

  2. Service Immunopharmacologie Hôpital Universitaire de Saint Etienne, Université Jean Monnet, Saint Priest en Jarez, France

    Stephane Paul

  3. Inserm, U954 et Service d’Hepato-Gastroenterologie, CHU de Nancy, Université de Lorraine, Vandoeuvre-lès-Nancy, France

    Laurent Peyrin-Biroulet

Authors
  1. Nicolas Williet
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  2. Stephane Paul
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  3. Laurent Peyrin-Biroulet
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  4. Xavier Roblin
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Corresponding author

Correspondence to Nicolas Williet.

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Conflict of interest

Nicolas Williet and Stephane Paul have no conflict of interest. Laurent Peyrin-Biroulet has received consulting and/or lecture fees from Merck, Abbott, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Shire, Therakos, Pharmacosmos, Pilège, BMS, UCB-pharma, Hospira, Takeda. Xavier Roblin has received consulting and/or lecture fees from MSD, Abbvie, Hospira.hac pharma, Théradiag, Takeda.

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Williet, N., Paul, S., Peyrin-Biroulet, L. et al. Pharmacokinetics of Infliximab and Reduction of Treatment for Inflammatory Bowel Diseases. Dig Dis Sci 61, 990–995 (2016). https://doi.org/10.1007/s10620-015-3984-2

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  • DOI: https://doi.org/10.1007/s10620-015-3984-2

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