alexa Systematic Review and Meta-Analysis: Serum Infliximab Levels During Maintenance Therapy and Outcomes in Inflammatory Bowel Disease.


Journal of Inflammatory Bowel Diseases & Disorders

Author(s): Moore C, Corbett G, Moss AC

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Abstract BACKGROUND AND AIMS: A number of observational studies have reported an association between serum levels of infliximab [IFX] at various thresholds, and clinical outcomes in inflammatory bowel disease [IBD]. This association has not previously been systematically analysed. METHODS: Systematic review of studies that reported serum infliximab levels according to outcomes in IBD. Primary outcome was clinical remission, and secondary outcomes included endoscopic remission, C-reactive protein [CRP] levels, and colectomy. Meta-analysis of raw data was performed where appropriate. A quality assessment was also undertaken. RESULTS: A total of 22 studies met the inclusion criteria, including 3483 patients; 12 studies reported IFX levels in a manner suitable for determining effect estimates. During maintenance therapy, patients in clinical remission had significantly higher mean trough IFX levels than patients not in remission: 3.1 µg/ml versus 0.9 µg/ml. The standardised mean difference in serum IFX levels between groups was 0.6 µg/ml (95\% confidence interval [CI] 0.4-0.9, p = 0.0002]. Patients with an IFX level > 2 µg/ml were more likely to be in clinical remission (risk ratio [RR] 2.9, 95\% CI 1.8-4.7, p < 0.001], or achieve endoscopic remission [RR 3, 95\% CI 1.4-6.5, p = 0.004] than patients with levels < 2 µg/ml. CONCLUSIONS: There is a significant difference between serum infliximab levels in patients with IBD in remission, compared with those who relapse. A trough threshold during maintenance > 2 µg/ml is associated with a greater probability of clinical remission and mucosal healing. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected]
This article was published in J Crohns Colitis and referenced in Journal of Inflammatory Bowel Diseases & Disorders

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