Article (Scientific journals)
Trough concentrations of infliximab guide dosing for patients with inflammatory bowel disease.
Vande Casteele, Niels; Ferrante, Marc; Van Assche, Gert et al.
2015In Gastroenterology, 148 (7), p. 1320-9.e3
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Keywords :
Gastrointestinal Agents/administration & dosage/adverse effects/blood/economics/pharmacokinetics; Humans; Infliximab; Male; Middle Aged; Recurrence; Remission Induction; Tertiary Care Centers; Treatment Outcome; Tumor Necrosis Factor-alpha/antagonists & inhibitors; Monoclonal Antibody; Personalized Medicine; Pharmacokinetics; Therapeutic Drug Monitoring
Abstract :
[en] BACKGROUND & AIMS: 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. METHODS: 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 mug/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. RESULTS: At screening, 115 of 263 patients had a TC of infliximab of 3-7 mug/mL (43.7%). Of 76 patients with TCs <3 mug/mL, 69 patients (91%) achieved TCs of 3-7 mug/mL after dose escalation. This resulted in a higher proportion of CD patients in remission than before dose escalation (88% vs 65%; P = .020) and a decrease in the median concentration of C-reactive protein, compared with before the dose increase (3.2 vs 4.3 mg/L; P < .001); these changes were not observed in patients with UC. Of 72 patients with TCs >7 mug/mL, 67 patients (93%) achieved TCs of 3-7 mug/mL after dose reduction. This resulted in a 28% reduction in drug cost from before dose reduction (P < .001). Sixty-six percent of patients whose dosing was based on clinical features and 69% whose dosing was based on TC achieved remission, the primary end point (P = .686). Disease relapsed in 21 patients who received clinically based dosing (17%) and 9 patients who received concentration-based dosing (7%) (P = .018). CONCLUSIONS: Targeting patients' infliximab TCs to 3-7 mug/mL results in a more efficient use of the drug. After dose optimization, continued concentration-based dosing was not superior to clinically based dosing for achieving remission after 1 year, but was associated with fewer flares during the course of treatment. ClinicalTrialsRegister.eu number: 2011-002061-38.
Disciplines :
Life sciences: Multidisciplinary, general & others
Author, co-author :
Vande Casteele, Niels
Ferrante, Marc
Van Assche, Gert
Ballet, Vera
Compernolle, Griet
Van Steen, Kristel  ;  Université de Liège > Dép. d'électric., électron. et informat. (Inst.Montefiore) > Bioinformatique
Simoens, Steven
Rutgeerts, Paul
Gils, Ann
Vermeire, Severine
Language :
English
Title :
Trough concentrations of infliximab guide dosing for patients with inflammatory bowel disease.
Publication date :
2015
Journal title :
Gastroenterology
ISSN :
0016-5085
eISSN :
1528-0012
Publisher :
Elsevier
Volume :
148
Issue :
7
Pages :
1320-9.e3
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright (c) 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
Available on ORBi :
since 12 June 2016

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