Monitoring antibodies a new approach for successful IBD treatment
Researchers are proposing a new way to help patients with Crohn's disease and colitis who are receiving Remicade (infliximab). According to current guidelines, dosing is based on symptoms and weight. Monitoring for therapeutic drug levels could be a new way to help patients maintain IBD remission and ensure patients don't develop antibodies that make the drug ineffective.
The study, published in the journal Inflammatory Bowel Diseases, evaluated the levels of infliximab that is commonly used to treat IBD. The drug works by blocking TNF-alpha, an inflammatory protein that is typically found in high levels in patients with Crohn's disease and ulcerative colitis.
Researchers believe infliximab stops working because people with Crohn's disease develop antibodies. According to background information from the study, two-thirds of patients initially respond to the drug that is commonly known as Remicade. Less than half of those given the drug stay in remission after one year.
Monitoring response to Remicade could boost response to therapy
For the pilot study researchers at Beth Israel Deaconess Medical Center enrolled forty-eight patients.
Patients given infliximab who were monitored closely for antibody levels were more likely to continue the therapy compared to those given standard dosing.
The study authors surmise maintaining target infliximab concentrations prevents antibodies from developing, making therapy more effective.
"Currently physicians are not routinely checking infliximab levels," said Cheifetz, Director of Center for Inflammatory Bowel Disease at BIDMC and an Associate Professor of Medicine at Harvard Medical School in a press release.
"In our study, patients who did not have proactive monitoring were three times more likely to stop infliximab. 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."
The new approach to IBD therapy would replace current practice of administering infliximab based on weight and patient's symptoms of Crohn's or colitis. Cheifetz added the finding could have implications for other autoimmune disorders such as psoriasis and rheumatoid arthritis. it's also possible antibody monitoring could help with Humira treatment. The next step is to verify the finding in larger studies so an algorithm for clinicians could be developed.