Trough level of infliximab is useful for assessing mucosal healing in Crohn's disease: a prospective cohort study

• Main Authors: Akihiro Koga, Toshiyuki Matsui, Noritaka Takatsu, Yasumichi Takada, Masahiro Kishi, Yutaka Yano, Takahiro Beppu, Yoichiro Ono, Kazeo Ninomiya, Fumihito Hirai, Takashi Nagahama, Takashi Hisabe, Yasuhiro Takaki, Kenshi Yao, Hirotsugu Imaeda, Akira Andoh
• Format: Article
• Language: English
• Published: Korean Association for the Study of Intestinal Diseases 2018-04-01
• Series: Intestinal Research
• Subjects: Crohn disease; Infliximab trough level; Mucosal healing; Loss of response; Antibodies to infliximab
• Online Access: http://www.irjournal.org/upload/pdf/ir-16-223.pdf
• ISSN: 1598-9100; 2288-1956

Background/AimsDecreased trough levels of infliximab (TLI) and antibodies to infliximab (ATI) are associated with loss of response (LOR) in Crohn's disease. Two prospective studies were conducted to determine whether TLI or ATI better correlates with LOR (Study 1), and whether TLI could become a predictor of mucosal healing (MH) (Study 2).MethodsStudy 1 was conducted in 108 patients, including those with LOR and remission to compare ATI and TLI in discriminating the 2 conditions based on receiver operating characteristic (ROC) curve analyses. Study 2 involved 35 patients who were evaluated endoscopically.ResultsIn Study 1, there were no differences between the 2 assays in ROC curve analyses; the TLI cutoff value for LOR was 2.6 µg/mL (sensitivity, 70.9%; specificity, 79.2%), and the ATI cutoff value was 4.9 µg/mL (sensitivity, 65.5%; specificity, 67.9%). The AUROC (area under the ROC curve) of TLI was greater than that of ATI. AUROC was useful for discriminating between the 2 conditions. In Study 2, the TLI was significantly higher in the colonic MH group than in the non-MH group (2.7 µg/mL vs. 0.5 µg/mL, P=0.032).ConclusionsTLI is better than ATI for clinically diagnosing LOR, and a correlation was observed between TLI and colonic MH.