P186 Association between anti-TNF serum levels and mucosal healing in inflammatory bowel disease

    loading  Checking for direct PDF access through Ovid

Abstract

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

Methods: Multicenter, prospective study. IBD patients under anti-TNF treatment for at least 6 months that had to undergo an endoscopy for medical indication were included. Patients with incomplete endoscopy, those with intestinal segments affected by the disease non-accessible to endoscopy, and those receiving anti-TNF to prevent postsurgical recurrence were excluded. MH was defined as: Simplified Endoscopic Score for Crohn's Disease (SES-CD)<3, Rutgeerts score

Anti-TNF concentrations were measured using SMART ELISAs (Sanquin Reagents, Amsterdam, The Netherlands)

Results: 182 patients were included; 50% were male, 70% had Crohn's disease and 49% had MH. 52% of patients were under adalimumab (ADA) and 48% under infliximab (IFX) treatment; 51% of patients had previously received another anti-TNF agent. 32% of patients were on concomitant treatment with thiopurines. IFX through levels (median) were significantly higher among patients that had MH than among those who did not (4.8 vs. 3 μg/mL, p=0.04). Similarly, ADA through levels were significantly higher among patients with MH (9.8 vs. 6.6 μg/mL, p=0.04). The accuracy of anti-TNF through levels to predict MH is shown in table 1. Concomitant treatment with immunomodulators had no impact on anti-TNF drug levels. In the multivariate analysis, to have anti-TNF drug levels above the threshold (3.4 μg/mL for IFX, and 7.2 μg/mL for ADA) and to have ulcerative colitis (instead of Crohn's disease) were the variables associated with a higher probability of having MH (OR=3.1, 95% CI: 1.5–6.5 and OR=4, 95% CI: 1.7–9.5, respectively). On the other hand, to have needed an escalated dosage (OR=0.2, 95% CI: 0.08–0.45) and to be current smoker (vs. non-smoker) (OR=0.2, 95% CI: 0.09–0.52) were associated with a lower probability of MH

Conclusions: There was an association between anti-TNF through levels and MH in IBD patients; however, the accuracy of the determination of both IFX and ADA concentrations to predict MH was suboptimal. To have IFX through levels above 3.4 μg/mL had a positive predictive value for MH of >70%.

Related Topics

    loading  Loading Related Articles