Trough concentrations of infliximab guide dosing for patients with inflammatory bowel disease

Gastroenterology
Niels Vande CasteeleSéverine Vermeire

Abstract

Infliximab, a tumor necrosis factor antagonist, is effective for treating patients with Crohn's disease (CD) and ulcerative colitis (UC). We aimed to determine whether dosing based on therapeutic drug monitoring increases rate of remission and whether continued concentration-based dosing is superior to clinically based dosing of infliximab for maintaining remission in patients with CD and UC. We performed a 1-year randomized controlled trial at a tertiary referral center, including 263 adults (178 with CD and 85 with UC) with stable responses to maintenance infliximab therapy. Doses were escalated or reduced using an algorithm to reach a target trough concentration (TC) of 3-7 μg/mL in all patients (optimization phase). Patients were randomly assigned (1:1) to groups that received infliximab dosing based on their clinical features (n = 123) or continued dosing based on TCs (n = 128) (maintenance phase). The primary end point was clinical and biochemical remission at 1 year after the optimization phase. At screening, 115 of 263 patients had a TC of infliximab of 3-7 μg/mL (43.7%). Of 76 patients with TCs <3 μg/mL, 69 patients (91%) achieved TCs of 3-7 μg/mL after dose escalation. This resulted in a higher proportion of CD patien...Continue Reading

Associated Clinical Trials

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Citations

Jan 15, 2016·Expert Review of Gastroenterology & Hepatology·Federica FurfaroSilvio Danese
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