Hepato-Gastroenterology Department, Saint-Louis Hospital, Université Paris VII, Paris, France.
Inflamm Bowel Dis. 2012 Jul;18(7):1199-206. doi: 10.1002/ibd.21839. Epub 2011 Aug 29.
Infliximab is effective for the treatment of refractory inflammatory bowel disease (IBD). Nevertheless, up to 40% of patients lose response to infliximab over time. The aim was to assess the clinical value of measuring infliximab trough levels and antibodies to infliximab (ATI) concentrations in IBD patients who lost response to infliximab therapy.
We retrospectively studied records of IBD patients who lost response to infliximab therapy. We first assessed clinical responses of different therapeutic strategies that were applied when patients lost response to infliximab and then we looked at the correlation between clinical response and infliximab trough levels and ATI concentrations.
Seventy-six IBD patients were included. 31/76 patients (41%) continued infliximab therapy without any modification, 39 patients (51%) had an intensification of infliximab therapy, five patients (7%) had switched to adalimumab therapy, and one patient (1%) underwent surgery. Clinical response was observed in 27 patients (69%) with an intensification of infliximab therapy. There was no significant difference in mean infliximab trough level at inclusion in patients who responded to intensification of infliximab therapy (3.3 ± 4.1 μg/mL) as compared with patients who did not respond (2.3 ± 2.2 μg/mL, P = 0.85). In all, 16/76 patients (22.4%) presented detectable ATI in the serum. Ten ATI-positive patients had an intensification of infliximab therapy and six (60%) demonstrated a clinical response. After intensification of infliximab therapy the ATI concentration decreased in five patients.
In patients with IBD who lose response to infliximab, clinical improvement may occur upon intensification of infliximab therapy, irrespective of infliximab serum concentration or presence of ATI.
英夫利昔单抗对治疗难治性炎症性肠病（IBD）有效。然而，多达 40%的患者随着时间的推移对英夫利昔单抗失去反应。目的是评估在对英夫利昔单抗治疗失去反应的 IBD 患者中测量英夫利昔单抗谷浓度和英夫利昔单抗抗体（ATI）浓度的临床价值。
我们回顾性研究了对英夫利昔单抗治疗失去反应的 IBD 患者的记录。我们首先评估了在患者对英夫利昔单抗失去反应时应用的不同治疗策略的临床反应，然后观察了临床反应与英夫利昔单抗谷浓度和 ATI 浓度之间的相关性。
共纳入 76 例 IBD 患者。31/76 例（41%）患者继续不改变英夫利昔单抗治疗，39 例（51%）患者英夫利昔单抗治疗强化，5 例（7%）患者换用阿达木单抗治疗，1 例（1%）患者接受手术。强化英夫利昔单抗治疗的 27 例（69%）患者观察到临床反应。在对强化英夫利昔单抗治疗有反应的患者（3.3±4.1μg/mL）和无反应的患者（2.3±2.2μg/mL，P=0.85）中，纳入时的平均英夫利昔单抗谷浓度无显著差异。76 例患者中共有 16 例（22.4%）血清中存在可检测的 ATI。10 例 ATI 阳性患者接受了英夫利昔单抗强化治疗，其中 6 例（60%）有临床反应。在强化英夫利昔单抗治疗后，5 例患者的 ATI 浓度降低。
在对英夫利昔单抗治疗失去反应的 IBD 患者中，无论英夫利昔单抗血清浓度或 ATI 存在与否，强化英夫利昔单抗治疗可能会导致临床改善。
