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Dig Dis Sci. 2019 Mar;64(3):846-854. doi: 10.1007/s10620-018-5362-3. Epub 2018 Nov 13.

Correlation Between Anti-TNF Serum Levels and Endoscopic Inflammation in Inflammatory Bowel Disease Patients.

Author information

1
Servicio de Aparato Digestivo, Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain. mariachs2005@gmail.com.
2
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. mariachs2005@gmail.com.
3
Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
4
Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Ferrol, Coruña, Spain.
5
Servicio de Farmacia, Hospital Universitario Rio Hortega, Valladolid, Spain.
6
Servicio de Aparato Digestivo, Hospital Universitario Rio Hortega, Valladolid, Spain.
7
Servicio de Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
8
Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa and IIS-Aragón, Saragossa, Spain.
9
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
10
Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
11
Servicio de Aparato Digestivo, Hospital Galdakao-Usansolo, Vizcaya, Spain.
12
Servicio de Aparato Digestivo, Hospital Universitari de Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain.
13
Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Madrid, Spain.
14
Servicio de Aparato Digestivo, Hospital Universitari La Fe, Valencia, Spain.
15
Servicio de Aparato Digestivo, Complejo Hospitalario la Mancha Centro, Ciudad Real, Spain.
16
Servicio de Aparato Digestivo, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.
17
Servicio de Aparato Digestivo, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
18
Servicio de Aparato Digestivo, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.
19
Servicio de Aparato Digestivo, Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
20
Servicio de Análisis Clínicos, Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.

Abstract

OBJECTIVES:

(a) To evaluate the diagnostic accuracy of anti-TNF trough levels to predict mucosal healing in inflammatory bowel disease (IBD); (b) to determine the best cut-off point to predict mucosal healing in IBD patients treated with anti-TNF.

METHODS:

This is a multicenter, prospective study. IBD patients under anti-TNF treatment for at least 6 months that had to undergo an endoscopy were included. Mucosal healing was defined as: Simple endoscopic score for Crohn's Disease < 3 for Crohn's disease (CD), Rutgeerts score < i2 for CD in postoperative setting, or Mayo endoscopic score ≤ 1 for ulcerative colitis (UC). Anti-TNF concentrations were measured using SMART ELISAs at trough.

RESULTS:

A total of 182 patients were included. Anti-TNF trough levels were significantly higher among patients that had mucosal healing than among those who did not. The area under the curve of infliximab for mucosal healing was 0.63 (best cutoff value 3.4 μg/mL), and for adalimumab 0.60 (best cutoff value 7.2 μg/mL). In the multivariate analysis, having anti-TNF drug levels above the cutoff values [odds ratio (OR) 3.1]) and having UC instead of CD (OR 4) were associated with a higher probability of having mucosal healing. Additionally, the need for an escalated dosage (OR 0.2) and current smoking habit (OR 0.2) were also associated with a lower probability of mucosal healing.

CONCLUSIONS:

There was an association between anti-TNF trough levels and mucosal healing in IBD patients; however, the accuracy of the determination of infliximab and adalimumab concentrations able to predict mucosal healing was suboptimal.

KEYWORDS:

Adalimumab; Anti-TNF; Crohn’s disease; Inflammatory bowel disease; Infliximab; Mucosal healing; Trough levels; Tumor necrosis factor alpha; Ulcerative colitis

PMID:
30426297
DOI:
10.1007/s10620-018-5362-3

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