Supratherapeutic infliximab levels do not predict complications risk in CD patients

10 Jan 2023
Supratherapeutic infliximab levels do not predict complications risk in CD patients

Trough levels of infliximab are not predictive of the risk of short-term infectious (IC) or noninfectious complications (NIC) in adult patients with Crohn’s disease (CD), reports a study.

A team of investigators retrospectively assessed a large cohort of CD patients who received infliximab and underwent therapeutic drug monitoring (TDM) at a tertiary inflammatory bowel disease centre between 1 January 2010 and 1 December 2019. TDM referred to the checking of infliximab trough and antibody levels within a 48-h period prior to administration.

Patients with a minimum assessment of 3 month pre- and post-TDM were included in the study. In cases of multiple TDMs, the highest trough level was considered. Participants were then assigned to four predefined trough level groups (A: <5 µg/mL; B: 5‒10 µg/mL; C: 10‒15 µg/mL; and D: ≥15 µg/mL).

The investigators compared the rates of IC and NIC during the 3-month prior and following TDM across groups. They also obtained the duration of exposure in terms of months leading to TDM to examine differences in IC and NIC rates.

A total of 342 CD patients (median age 35 years, 58 percent men) were included. IC occurred in 52 patients (15 percent) and NIC in 30 (9 percent). IC (p=0.9) and NIC rates (p=0.7) were similar across the four trough level groups.

Multivariable analysis revealed that exposure to infliximab >40 months (as determined by receiver operating characteristic curve analysis) correlated with a lower likelihood for IC (adjusted odds ratio [aOR], 0.51; p=0.04) but not NIC (aOR, 0.72; p=0.46).

These findings “support the safety of targeting higher infliximab trough levels when necessary and greater vigilance during the early stages of treatment,” the investigators said.

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