Infliximab Trough Levels and Quality of Life in Patients with Inflammatory Bowel Disease in Maintenance Therapy

Abstract

Objective Investigate the association between infliximab trough levels and quality of life in inflammatory bowel disease patients in maintenance therapy. Methods We carried out a transversal study with inflammatory bowel disease patients in infliximab maintenance therapy. Infliximab trough levels were determined using a quantitative rapid test. Disease activity indices (partial Mayo Score and Harvey-Bradshaw Index) and endoscopic scores (endoscopic Mayo Score or Simple Endoscopic Score in Crohn's disease) were obtained. Quality of life was assessed using the Inflammatory Bowel Disease Questionnaire (IBDQ). Results Seventy-one consecutive subjects were included in the study (55 with Crohn's disease and 16 with ulcerative colitis). Drug levels were considered satisfactory (≥3 μg/mL) in 28 patients (39.4%) and unsatisfactory (<3 μg/mL) in 43 (60.6%). Satisfactory trough levels were associated with higher rates of clinical remission and mucosal healing. Higher trough levels were also associated with improved IBDQ scores, particularly regarding bowel symptoms, systemic function, and social function. Conclusion Satisfactory trough levels of infliximab were associated with higher rates of clinical remission, mucosal healing, and improved quality of life in inflammatory bowel disease patients on maintenance therapy.

Serum levels of infliximab in Brazilian patients with Crohn's disease: what are the reasons for differences from previous studies?

“…The proportion of patients with supra-therapeutic levels was 17.46% according to Kampa et al in a study using ELISA kits that were shipped and analyzed in Leuven, Belgium, which also included UC patients (4). Similar supra-therapeutic levels were found by Parra et al (11.3%) in a study using the Quantum Blue rapid test (5). In another multicentric study, similar proportions were also found (8.16% with a different ELISA assay and 16.33% with the Quantum Blue rapid test) (6).…”

Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

“…In 2007, a European survey observed that 75.6% of IBD patients reported having symptoms that interfered with their ability to enjoy leisure activities, and almost 70% stated that their symptoms negatively affected work performance[11]. Patients with an active disease usually have poor QoL[2,12], but other studies[13,14] have observed that stress level, anxiety or depression, female gender, and fatigue can also contribute to poor QoL in IBD patients. Several studies[12,15,16] have also shown that IBD impacts work productivity.…”

Authors' Reply – Comments: Serum levels of infliximab in Brazilian patients with Crohn's disease: what are the reasons for differences from previous studies?

“…We would like to thank Teixeira et al 1 for their comments on our article 2. They correctly noted that the majority of our patients presented infliximab (IFX) levels above the therapeutic concentration, differing from three other Brazilian studies published between 2017 and 2018 3-5. However, there are several significant conceptual and methodological differences between those studies and ours that need to be taken into consideration to understand the factors that led to such contrasting results.…”

“…Teixeira et al 4 even suggested that more studies on patients with active disease would be necessary. Finally, Parra et al 5 evaluated the levels of IFX in a larger cohort of 55 patients with CD and 16 with UC. The novelty of this study was the use of a quality of life questionnaire and its correlation with the serum trough levels of IFX.…”

“…By contrast, we only took into consideration the interval of up to one month before or after sample collection. Moreover, as acknowledged by Parra et al 5 themselves, they did not include variables for either proinflammatory biomarkers (such as CRP and fecal calprotectin) or body mass index (BMI) in their analysis. We assessed the serum albumin levels of all patients included in our research.…”