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Garcia KS, de Azevedo MFC, Carlos ADS, Barros LL, Oba J, Sobrado Junior CW, Sipahi AM, Alves ODDC, Navarro-Rodriguez T, Parra RS, Chebli JMF, Chebli LA, Flores C, Vieira A, do Ceará CDA, Queiroz NSF, Damião AOMC. Efficacy of Early Optimization of Infliximab Guided by Therapeutic Drug Monitoring during Induction-A Prospective Trial. Biomedicines 2023; 11:1757. [PMID: 37371853 DOI: 10.3390/biomedicines11061757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Therapeutic drug monitoring (TDM) during induction therapy with anti-tumor necrosis factor drugs has emerged as a strategy to optimize response to these biologics and avoid undesired outcomes related to inadequate drug exposure. This study aimed to describe clinical, biological, and endoscopic remission rates at six months in Brazilian inflammatory bowel disease (IBD) patients following a proactive TDM algorithm guided by IFX trough levels (ITL) and antibodies to IFX (ATI) levels during induction, at week six. A total of 111 IBD patients were prospectively enrolled, excluding those previously exposed to the drug. ITL ≥ 10 μg/mL was considered optimal. Patients with suboptimal ITL (<10 µg/mL) were guided according to ATI levels. Those who presented ATI ≤ 200 ng/mL underwent dose intensification in the maintenance phase, and patients with ATI > 200 ng/mL discontinued IFX. In our study, proactive TDM was associated with persistence in the IFX rate at six months of 82.9%. At that time, rates of clinical, biological, and endoscopic remission in patients under IFX treatment were 80.2%, 73.9%, and 48.1%, respectively. Applying a simplified TDM-guided algorithm during induction seems feasible and can help improve patients' outcomes in clinical practice.
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Affiliation(s)
- Karoline Soares Garcia
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Alexandre de Sousa Carlos
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Luísa Leite Barros
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Jane Oba
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Aytan Miranda Sipahi
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Tomás Navarro-Rodriguez
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Rogério Serafim Parra
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | | | - Liliana Andrade Chebli
- University Hospital of the Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil
| | - Cristina Flores
- Crohn's and Colitis Reference Center, Rio Grande do Sul 90560-002, Brazil
| | - Andrea Vieira
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo 01221-010, Brazil
| | | | - Natália Sousa Freitas Queiroz
- Health Sciences Graduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil
- IBD Center, Santa Cruz Hospital, Curitiba 80420-090, Brazil
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