Proactively Monitoring Inflammatory Bowel Disease Therapy Could Improve Its Efficacy

Researchers at Beth Israel Deaconess Medical Center (BIDMC) reported that proactive monitoring of dose adjustments of infliximab (IFX), one of the 4 anti-TNF-alpha proteins used to treat inflammatory diseases like Crohn’s disease (CD), ulcerative colitis (UC), and inflammatory bowel disease (IBD), could prolong the effectiveness of treatment.

Published in the Inflammatory Bowel Disease Journal, the observational study focused on monitoring therapeutic concentration levels of infliximab in IBD patients, allowing clinicians to gradually adjust treatment dosage to ultimately decrease toxicity.

While IFX has a solid track record of maintaining remission of moderate to severe IBD in patients, the therapy has not yet been proven completely durable in treatment, presumably due to the production of antibodies to the drug. Notably, at the one year mark, fewer than 50% of patients remain in remission, and also, 10% of patients administered IFX will gradually lose their response to the treatment.

Researchers found a significant difference between the results of patients who experienced proactive monitoring concentrations of IFX and those who were simply administered standard dosing and treatment. Proactive monitoring was associated with an increased chance of continuing therapy. Experts believe sustaining a target IFX level prevents antibody formation.

Adam S. Chiefetz, MD, Director of Center for IBD at BIDMC and Associate Professor of Medicine at Harvard Medical School, commented, “In our study, patients who did not have proactive monitoring were three times more likely to stop infliximab (IFX). Therefore, we are proposing that all patients have routine monitoring of IFX concentrations and adjustment of dose based on the level, even if clinically well.”

“This would be a huge paradigm shift for patients on IFX. Instead of just weight based dosing with empiric dose escalation for symptoms, we propose monitoring the serum drug concentrations and adjusting the dose to achieve a drug concentration within the therapeutic range,” said Chiefetz.