Infliximab Monitoring Improves the Control of Disease Activity in RA
Infliximab Monitoring Improves the Control of Disease Activity in RA
Introduction Adjustment of infliximab dosage for individuals may be useful in improving therapeutic response in rheumatoid arthritis (RA). Herein, we aimed to determine whether measurement of infliximab serum concentration modifies the therapeutic decision and improves the control of disease activity.
Methods RA patients routinely treated with infliximab were included in an observational open-label study. On visit 1 (V1), according to the disease activity, a preliminary therapeutic decision was selected among four therapeutic options and a blood sample was collected to measure trough serum infliximab concentration. The final therapeutic decision, based on both disease activity and serum infliximab concentration assessed at V1, was applied at the following infusion (V2). Clinical and biological evaluations were performed at V3 and V4 and compared with those at V1.
Results We included 24 patients. The final therapeutic decision differed from the preliminary decision for 12 patients (50%). For patients with increased infliximab dosage at V2, mean disease activity score for 28 joints (DAS28) decreased by about 20% at V3 or V4 as compared with V1 (P < 0.05). Decreased DAS28 was correlated with increased serum infliximab concentration (P < 0.02).
Conclusions The measurement of infliximab trough concentration modifies the therapeutic decision for RA patients and helps improve control of disease activity. Therapeutic drug monitoring of infliximab in RA may be useful for individual dosage adjustment.
Infliximab is a chimeric monoclonal antibody against tumor necrosis factor-alpha (TNF-α) used in the treatment of rheumatoid arthritis (RA); its efficacy was demonstrated in a randomized controlled trial. The variable inter-individual response is explained at least in part by individual pharmacokinetics. Clinical response in RA is indeed influenced by infliximab serum concentration, and we have recently shown that this concentration predicts long-term disease control in daily practice. Adjustment of infliximab dosage for individuals may be useful in improving therapeutic response. Hence, patients with persistent active disease and low infliximab concentrations could benefit from an increase in infliximab dosage, whereas those with poor disease control and high infliximab concentrations should switch to another biopharmaceutical. In contrast, patients with optimal disease control and high infliximab concentrations might benefit from a controlled reduction in infliximab dose or an increase of dosing intervals to decrease the risk of dose-related side effects.
We aimed to determine whether the measurement of serum infliximab concentration modifies the therapeutic strategy and improves the control of disease activity in RA. The secondary objective was to study whether this improvement in control of disease activity is related to changes in infliximab concentration.
Abstract and Introduction
Abstract
Introduction Adjustment of infliximab dosage for individuals may be useful in improving therapeutic response in rheumatoid arthritis (RA). Herein, we aimed to determine whether measurement of infliximab serum concentration modifies the therapeutic decision and improves the control of disease activity.
Methods RA patients routinely treated with infliximab were included in an observational open-label study. On visit 1 (V1), according to the disease activity, a preliminary therapeutic decision was selected among four therapeutic options and a blood sample was collected to measure trough serum infliximab concentration. The final therapeutic decision, based on both disease activity and serum infliximab concentration assessed at V1, was applied at the following infusion (V2). Clinical and biological evaluations were performed at V3 and V4 and compared with those at V1.
Results We included 24 patients. The final therapeutic decision differed from the preliminary decision for 12 patients (50%). For patients with increased infliximab dosage at V2, mean disease activity score for 28 joints (DAS28) decreased by about 20% at V3 or V4 as compared with V1 (P < 0.05). Decreased DAS28 was correlated with increased serum infliximab concentration (P < 0.02).
Conclusions The measurement of infliximab trough concentration modifies the therapeutic decision for RA patients and helps improve control of disease activity. Therapeutic drug monitoring of infliximab in RA may be useful for individual dosage adjustment.
Introduction
Infliximab is a chimeric monoclonal antibody against tumor necrosis factor-alpha (TNF-α) used in the treatment of rheumatoid arthritis (RA); its efficacy was demonstrated in a randomized controlled trial. The variable inter-individual response is explained at least in part by individual pharmacokinetics. Clinical response in RA is indeed influenced by infliximab serum concentration, and we have recently shown that this concentration predicts long-term disease control in daily practice. Adjustment of infliximab dosage for individuals may be useful in improving therapeutic response. Hence, patients with persistent active disease and low infliximab concentrations could benefit from an increase in infliximab dosage, whereas those with poor disease control and high infliximab concentrations should switch to another biopharmaceutical. In contrast, patients with optimal disease control and high infliximab concentrations might benefit from a controlled reduction in infliximab dose or an increase of dosing intervals to decrease the risk of dose-related side effects.
We aimed to determine whether the measurement of serum infliximab concentration modifies the therapeutic strategy and improves the control of disease activity in RA. The secondary objective was to study whether this improvement in control of disease activity is related to changes in infliximab concentration.
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