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Hindryckx P, Novak G, Vande Casteele N, Laukens D, Parker C, Shackelton LM, Narula N, Khanna R, Dulai P, Levesque BG, Sandborn WJ, D’Haens G, Feagan BG, Jairath V. Review article: dose optimisation of infliximab for acute severe ulcerative colitis. Aliment Pharmacol Ther 2017; 45:617-630. [PMID: 28074618 PMCID: PMC6658182 DOI: 10.1111/apt.13913] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 10/25/2016] [Accepted: 11/30/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although optimal medical management of acute severe ulcerative colitis (UC) is ill-defined, infliximab has become a standard of care. Accumulating evidence suggests an increased rate of infliximab clearance in patients with acute severe UC and a reduced colectomy rate with an intensified infliximab induction regimen. AIM To assess the strength of the current evidence for the relationship between infliximab pharmacokinetics, dosing strategies and disease behaviour in patients with acute severe UC. METHODS We systematically searched MEDLINE and conference proceedings from 2000 to 2016 for relevant articles describing the pharmacokinetics of infliximab in acute severe UC and/or infliximab dose intensification strategies in acute severe UC. Eligible articles described randomised controlled trials, and cohort, cross-sectional, and case-controlled studies. RESULTS Of 400 citations identified, 76 studies were eligible. Increased infliximab clearance occurs in patients with acute severe UC, and is driven by the total inflammatory burden and leakage of drug into the colonic lumen. Several cohort studies suggest that infliximab dose intensification is beneficial to at least 50% of acute severe UC patients and the results of case-controlled studies indicate that an intensified infliximab dosing regimen with 1-2 additional infusions in the first 3 weeks of treatment could reduce the early (3-month) colectomy rate by up to 80%, although these data require prospective validation. CONCLUSIONS Uncontrolled studies suggest a benefit for infliximab dose optimisation in patients with acute severe UC. A randomised controlled trial in acute severe UC patients comparing a personalised infliximab dose-optimisation strategy with conventional dosing is a research priority.
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Affiliation(s)
- P. Hindryckx
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
- Department of Gastroenterology, University of Ghent, Ghent, Belgium
| | - G. Novak
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
- Department of Gastroenterology, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - N. Vande Casteele
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
| | - D. Laukens
- Department of Gastroenterology, University of Ghent, Ghent, Belgium
| | - C. Parker
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
| | - L. M Shackelton
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
| | - N. Narula
- Department of Medicine and Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | - R. Khanna
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - P. Dulai
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - B. G Levesque
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - W. J Sandborn
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - G. D’Haens
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
- Inflammatory Bowel Disease Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | - B. G. Feagan
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - V. Jairath
- Robarts Clinical Trials, Inc., University of Western Ontario, London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
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