Sa1888 Need for Infliximab Dose Intensification in Patients With Crohns Disease and Ulcerative Colitis

Taxonera, Carlos; Mendoza, Juan L.; Olivares, David; Cañas, María M.; Arévalo, Fermín Estremera; Dı́az-Rubio, Manuel

doi:10.1016/s0016-5085(12)61323-7

Cited by 3 publications

(3 citation statements)

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“…Other studies have demonstrated a LOR in CD from 21% to 54% and a recent analysis of 16 studies suggested the annual risk for LOR is 13.1% per patient‐year (7,15,18–20). In UC, there are similar studies demonstrating the need for dose optimization in 42% to 58% of patients (11,21–23). Our study did not specifically examine symptomatic LOR, but demonstrated similar results when considering low IFX levels with 48 of 129 (37.2%) children who required dose optimization based on serum IFX levels <3 μg/mL.…”

Section: Discussionmentioning

confidence: 92%

Infliximab Optimization Based on Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease

Hofmekler

Bertha

McCracken

et al. 2017

J. pediatr. gastroenterol. nutr.

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Section: Discussionmentioning

confidence: 92%

Infliximab Optimization Based on Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease

Hofmekler

Bertha

McCracken

et al. 2017

J. pediatr. gastroenterol. nutr.

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“…33 This relatively worse outcome of anti-TNF in UC patients was indirectly supported by frequent and early requirement of dose intensification in patients with UC than in those with CD. UC patients had a higher adjusted rate of dose escalation than CD patients in both infliximab (aHR = 2.73; 95% CI: 1.31-5.69, P = 0.007) 34 and adalimumab (aHR = 2.33; 95% CI: 1.19-4.56, P = 0.013). 35 Shorter duration for drug discontinuation in UC patients than in CD patients in our study partially supports the lower effectiveness of infliximab in patients with UC.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Pharmacokinetics of CT-P13 Between Crohn’s Disease and Ulcerative Colitis

Kim

Park

et al. 2022

Journal of Clinical Gastroenterology

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Background: We aimed to compare trough infliximab levels and the development of antidrug antibody (ADA) for 1 year between Crohn’s disease (CD) and ulcerative colitis (UC) patients who were biologic-naive, and to evaluate their impact on clinical outcomes. Methods: This was a prospective, multicenter, observational study. Biologic-naive patients with moderate to severe CD or UC who started CT-P13, an infliximab biosimilar, therapy were enrolled. Trough drug and ADA levels were measured periodically for 1 year after CT-P13 initiation. Results: A total of 267 patients who received CT-P13 treatment were included (CD 168, UC 99). The rates of clinical remission (72% vs. 32.3%, P<0.001) at week 54 were significantly higher in CD than in UC. The median trough drug level (μg/mL) was significantly higher in CD than in UC up to week 14 (week 2, 18.7 vs. 14.7, P<0.001; week 6, 12.5 vs. 8.6, P<0.001; week 14, 3.4 vs. 2.5, P=0.001). The median ADA level (AU/mL) was significantly lower in CD than in UC at week 2 (6.3 vs. 6.5, P=0.046), week 30 (7.9 vs. 11.8, P=0.007), and week 54 (9.3 vs. 12.3, P=0.032). Development of ADA at week 2 [adjusted odds ratio (aOR)=0.15, P=0.026], initial C-reactive protein level (aOR=0.87, P=0.032), and CD over UC (aOR=1.92, P<0.001) were independent predictors of clinical remission at week 54. Conclusion: Infliximab shows more favorable pharmacokinetics, including high drug trough and low ADA levels, in CD than in UC, which might result in better clinical outcomes for 1-year infliximab treatment in CD patients.

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“…The simpler Harvey–Bradshaw index (HBI) may be a more suitable tool for the assessment of disease activity in clinical practice (Supplementary Table 6), but this is also weighted by diarrhea meaning that CD patients with an increased stool frequency are likely to show a score disproportionate to disease activity [ 1 , 54 ]. Studies using the HBI generally define lack of response as a score of ≥ 5 [ 28 , 42 ], although some have used a score of > 4 [ 60 , 61 ]. HBI scores are highly correlated with CDAI scores (correlation coefficient of 0.8–0.93) [ 61 , 62 ]; an HBI score > 4 is equivalent to a CDAI score of > 150 [ 61 ].…”

Section: Consensus Recommendationsmentioning

confidence: 99%

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

et al. 2023

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Background We aimed to develop criteria for treatment intensification in patients with (1) luminal Crohn’s disease (CD), (2) CD with perianal disease and/or fistula, (3) CD with small bowel stenosis, (4) in the postoperative setting, and (5) for discontinuing or reducing the dose of treatment in patients with CD. Methods PubMed and Embase were searched for studies published since 1998 which may be relevant to the five defined topics. Results were assessed for relevant studies, with preference given to data from randomized, controlled studies. For each question, a core panel of 12 gastroenterologists defined the treatment target and developed statements, based on the literature, current guidelines, and relevant additional studies. The evidence supporting each statement was graded using the Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). A modified Delphi process was used to refine statements and gain agreement from 54 Japanese specialists at in-person and online meetings conducted between October 2020 and April 2021. Results Seventeen statements were developed for treatment intensification in luminal CD (targeting endoscopic remission), six statements for treatment intensification in perianal/fistulizing CD (targeting healing of perianal lesions and complete closure of the fistula), six statements for treatment intensification in CD with small bowel stenosis (targeting resolution of obstructive symptoms), seven statements for treatment intensification after surgery (targeting endoscopic remission), and five statements for discontinuing or reducing the dose of treatment in patients with CD. Conclusions These statements provide guidance on how and when to intensify or de-intensify treatment for a broad spectrum of patients with CD.

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Sa1888 Need for Infliximab Dose Intensification in Patients With Crohns Disease and Ulcerative Colitis

Cited by 3 publications

References 0 publications

Infliximab Optimization Based on Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease

Infliximab Optimization Based on Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease

Comparison of the Pharmacokinetics of CT-P13 Between Crohn’s Disease and Ulcerative Colitis

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

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