Document Detail


Clinical utility of measuring infliximab and human anti-chimeric antibody concentrations in patients with inflammatory bowel disease.
MedLine Citation:
PMID:  20145610     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Human anti-chimeric antibodies (HACAs) and subtherapeutic infliximab concentrations are associated with decreased duration of response. We evaluated the clinical utility of measuring HACA and infliximab concentrations. METHODS: The medical records of patients with inflammatory bowel disease (IBD) who had HACA and infliximab concentrations measured were reviewed to determine whether the result affected clinical management. RESULTS: One hundred fifty-five patients had HACA and infliximab concentrations measured. The main indications for testing were loss of response to infliximab (49%), partial response after initiation of infliximab (22%), and possible autoimmune/delayed hypersensitivity reaction (10%). HACAs were identified in 35 patients (23%) and therapeutic infliximab concentrations in 51 patients (33%). Of 177 tests assessed, the results impacted treatment decisions in 73%. In HACA-positive patients, change to another anti-tumor necrosis factor (TNF) agent was associated with a complete or partial response in 92% of patients, whereas dose escalation had a response of 17%. In patients with subtherapeutic infliximab concentrations, dose escalation was associated with complete or partial clinical response in 86% of patients whereas changing to another anti-TNF agent had a response of 33%. Patients with clinical symptoms and therapeutic infliximab concentrations were continued at the same dose 76% of the time and had no evidence of active inflammation by endoscopic/radiographic assessment 62% of the time. CONCLUSIONS: Measurement of HACA and infliximab concentration impacts management and is clinically useful. Increasing the infliximab dose in patients who have HACAs is ineffective, whereas in patients with subtherapeutic infliximab concentrations, this strategy may be a good alternative to changing to another anti-TNF agent.
Authors:
Waqqas Afif; Edward V Loftus; William A Faubion; Sunanda V Kane; David H Bruining; Karen A Hanson; William J Sandborn
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2010-02-09
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  105     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-06     Completed Date:  2010-06-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1133-9     Citation Subset:  IM    
Affiliation:
Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antibodies, Anti-Idiotypic / immunology,  metabolism*
Antibodies, Monoclonal / metabolism*,  therapeutic use
Biological Markers / analysis
Cohort Studies
Colitis, Ulcerative / drug therapy,  immunology,  pathology
Crohn Disease / drug therapy,  immunology,  pathology
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Delivery Systems
Female
Follow-Up Studies
Humans
Inflammatory Bowel Diseases / drug therapy*,  immunology*,  pathology
Male
Probability
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Treatment Outcome
Tumor Necrosis Factor-alpha / antagonists & inhibitors*,  immunology
Young Adult
Grant Support
ID/Acronym/Agency:
1 UL1 RR024150/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Antibodies, Anti-Idiotypic; 0/Antibodies, Monoclonal; 0/Biological Markers; 0/Tumor Necrosis Factor-alpha; 0/infliximab
Comments/Corrections
Comment In:
Am J Gastroenterol. 2010 May;105(5):1140-1   [PMID:  20445512 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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