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The Impact of Combination Therapy on Infliximab Levels and Antibodies in Children and Young Adults With Inflammatory Bowel Disease.
Chi, Lisa Yue; Zitomersky, Naamah Levy; Liu, Enju; Tollefson, Sophia; Bender-Stern, Julia; Naik, Snehal; Snapper, Scott; Bousvaros, Athos.
Affiliation
  • Chi LY; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
  • Zitomersky NL; Harvard Medical School, Boston, Massachusetts.
  • Liu E; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
  • Tollefson S; Harvard Medical School, Boston, Massachusetts.
  • Bender-Stern J; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
  • Naik S; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts.
  • Snapper S; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
  • Bousvaros A; Harvard Medical School, Boston, Massachusetts.
Inflamm Bowel Dis ; 24(6): 1344-1351, 2018 05 18.
Article in En | MEDLINE | ID: mdl-29718278
ABSTRACT
Goal The aim of this study was to evaluate the effect of combination therapy with methotrexate or 6-mercaptopurine on infliximab levels (IFXL) and antibodies to infliximab (ATI).

Background:

Infliximab (IFX) is a highly effective therapy for inflammatory bowel disease (IBD). Unfortunately, 25%-50% of patients will lose response to IFX. Loss of response is correlated with low IFXL and ATI formation which accelerates drug clearance. Combination therapy is thought to decrease ATI formation.

Methods:

We performed a cross-sectional analysis of 223 pediatric and young adult patients with IBD on IFX. IFXL and ATI were measured and compared between subjects on current combination therapy, prior combination therapy, and IFX monotherapy.

Results:

Eighty-four (37.7%) patients were on combination therapy and 139 (62.3%) were on IFX monotherapy. Within the current monotherapy group, 112 (80.6%) had previously been on combination therapy, while 27 (19.4%) had never been on a concomitant immunomodulator. Patients currently on combination therapy had a higher IFXL (17.00 ± 1.33 µg/mL) than those currently on IFX monotherapy (13.18 ± 1.26 µg/mL), P < 0.01. IFXL was lowest in patients who had never been on combination therapy (11.53 ± 2.05 µg/mL) and highest in patients currently on combination therapy (17.00 ± 1.33 µg/mL). Patients currently on combination therapy had a lower rate of detectable ATI (9.5%) compared with those on monotherapy (20.0%) in multivariate analysis (odds ratio [OR] 0.3; 95% confidence interval (CI), 0.1-0.7, P < 0.01).

Conclusions:

Current or prior combination therapy is associated with higher IFXL and lower rates of ATI formation.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Inflammatory Bowel Diseases / Infliximab Type of study: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limits: Adolescent / Adult / Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: Inflamm Bowel Dis Journal subject: GASTROENTEROLOGIA Year: 2018 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Inflammatory Bowel Diseases / Infliximab Type of study: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limits: Adolescent / Adult / Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: Inflamm Bowel Dis Journal subject: GASTROENTEROLOGIA Year: 2018 Document type: Article