Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Gastroenterology & Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
BMJ Open Gastroenterol. 2021 Nov;8(1). doi: 10.1136/bmjgast-2021-000788.
Infliximab is an efficacious therapy for inflammatory bowel disease and may play a role in management of some extraintestinal manifestations. While higher trough levels of infliximab are associated with higher rates of disease remission, the association between trough levels of infliximab and arthralgia activity characterised as an extraintestinal manifestation has yet to be defined.
We aimed to assess the association between serum trough levels of infliximab and peripheral arthralgia activity in patients with inflammatory bowel disease.
In this cross-sectional study, we identified patients with inflammatory bowel disease on infliximab therapy with known history of arthralgias attributed to an extraintestinal manifestation. Collected variables included disease phenotype, medications (such as thiopurines or methotrexate), Harvey Bradshaw Index, partial Mayo score, C reactive protein, trough levels of infliximab and anti-infliximab antibodies. The primary outcome was active patient-reported arthralgia.
Out of 267 patients included, 65 (24.4%) had active arthralgias at the time the trough level of infliximab was measured. No significant differences in trough levels were seen between those patients with and without arthralgias. Patients on combination therapy with methotrexate or thiopurines or those with detectable anti-infliximab antibodies were not more likely to have inactive arthralgias (OR 0.99, 95% CI 0.57 to 1.74, p=0.99 and OR 1.94, 95% CI 0.9 to 4.1, p=0.09, respectively).
This study suggests that although therapeutic drug monitoring of infliximab can have a role in the management of Crohn's disease and ulcerative colitis, it does not seem to be useful in managing arthralgias associated with inflammatory bowel disease.
英夫利昔单抗是一种有效的炎症性肠病治疗药物，可能在某些肠外表现的治疗中发挥作用。虽然英夫利昔单抗的谷浓度较高与疾病缓解率较高有关，但英夫利昔单抗的谷浓度与作为肠外表现的关节痛活动之间的关联尚未确定。
我们旨在评估炎症性肠病患者英夫利昔单抗的血清谷浓度与外周关节痛活动之间的关系。
在这项横断面研究中，我们确定了正在接受英夫利昔单抗治疗且有已知归因于肠外表现的关节痛病史的炎症性肠病患者。收集的变量包括疾病表型、药物（如硫嘌呤或甲氨蝶呤）、Harvey Bradshaw 指数、部分 Mayo 评分、C 反应蛋白、英夫利昔单抗的谷浓度和抗英夫利昔单抗抗体。主要结局是患者报告的活跃关节痛。
在纳入的 267 名患者中，65 名（24.4%）在测量英夫利昔单抗谷浓度时有关节痛活跃。有和没有关节痛的患者之间的谷浓度没有显著差异。接受甲氨蝶呤或硫嘌呤联合治疗或检测到抗英夫利昔单抗抗体的患者不太可能有关节痛不活跃（OR 0.99，95%CI 0.57 至 1.74，p=0.99 和 OR 1.94，95%CI 0.9 至 4.1，p=0.09）。
这项研究表明，尽管英夫利昔单抗的治疗药物监测在克罗恩病和溃疡性结肠炎的管理中可能发挥作用，但它似乎对管理与炎症性肠病相关的关节痛没有帮助。
