Proactive IBD Monitoring Improves Patient Outcomes

Proactive monitoring of the serum concentration of infliximab is associated with better clinical outcomes compared with reactive monitoring in patients with inflammatory bowel disease (IBD), according to a recent study.

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Monitoring serum concentrations of tumor necrosis factor antagonists in patients with IBD is typically reactive (when the patient loses response) or proactive (when the drug is titrated to a target concentration for patients in clinical remission).

For their study, the researchers evaluated 264 patients with IBD on infliximab maintenance therapy, of whom 167 had Crohn disease, from September 2006 to January 2015. Over the course of the study, patients received either proactive (n=130) or reactive (n=134) drug monitoring, based on measurements of first infliximab concentration and antibodies to infliximab. Follow-up lasted a median of 2.4 years.

Time to treatment failure, first IBD-related surgery or hospitalization, serious infusion reaction, and detection of antibodies to infliximab were recorded and assessed. The researchers defined treatment failure as discontinuation of the study drug due to loss of response or serious adverse event, or the need for surgery.

Results of a multiple Cox regression analysis indicated that proactive drug monitoring was independently associated with a reduced risk for treatment failure, IBD-related surgery, IBD-related hospitalization, antibodies to infliximab, and serious infusion reaction, compared with reactive drug monitoring.

“In a retrospective analysis of patients with IBD receiving proactive vs reactive monitoring of serum concentration of infliximab, proactive monitoring was associated with better clinical outcomes, including greater drug durability, less need for IBD-related surgery or hospitalization, and lower risk of antibodies to infliximab or serious infusion reactions,” the researchers concluded.

—Christina Vogt

Reference:

Papamichael K, Chachu KA, Vajravelu RK, et al. Improved long-term outcomes of patients with inflammatory bowel disease receiving proactive compared with reactive monitoring of serum concentrations of infliximab. Clin Gastroenterol Hepatol. 2017;15(10):1580-1588.e3. http://www.cghjournal.org/article/S1542-3565(17)30385-3/fulltext.