Gut Liver.  2017 Jan;11(1):55-61. 10.5009/gnl16041.

Clinical Use of Measuring Trough Levels and Antibodies against Infliximab in Patients with Pediatric Inflammatory Bowel Disease

• Choi SY
• Kang B
• Lee JH
• Choe YH

• KMID: 2412155
• DOI: http://doi.org/10.5009/gnl16041

Abstract

BACKGROUND/AIMS
The clinical use of measuring infliximab (IFX) trough levels (TLs) and antibodies against IFX (ATIs) in patients with pediatric inflammatory bowel disease (IBD) remains unclear. We propose measuring these variables to create individual IFX treatment strategies for patients with pediatric IBD.
METHODS
This retrospective study was conducted in pediatric patients with IBD who received IFX from July 2009 to June 2014.
RESULTS
Samples were available from 39 patients with pediatric IBD. A significant difference was observed in IFX TLs in 16 patients who were in clinical remission (group A) after IFX therapy (median, 3.99 μg/mL; interquartile range [IQR], 0.30 to 21.96) compared to 23 patients who had a poor response to treatment (group B) (median, 0.88 μg/mL; IQR, 0.00 to 6.80, p=0.002). In group B, 21 patients underwent empiric intensification of IFX treatment. After dose intensification, 17 patients had an improved response to treatment. Four patients still had no response to dose intensification. Therefore, these patients were switched to other biologics.
CONCLUSIONS
Patients who had poor responses and subtherapeutic IFX TLs had an improved response to dose intensification. Patients who had ATIs were likely to continue to have no response after dose intensification. Therefore, tailoring individual IFX treatments based on IFX TLs, ATIs, and the clinical response should be considered.

Keyword

Pediatric inflammatory bowel disease; Infliximab; Trough level; Antibodies

MeSH Terms

Adolescent
Antibodies/*blood/immunology
Child
Colitis, Ulcerative/*drug therapy
Crohn Disease/*drug therapy
Drug Monitoring
Enzyme-Linked Immunosorbent Assay
Female
Gastrointestinal Agents/blood/immunology/*therapeutic use
Humans
Infliximab/blood/immunology/*therapeutic use
Male
Remission Induction
Retrospective Studies
Treatment Outcome
Antibodies
Gastrointestinal Agents
Infliximab