Infliximab Maintains IBD Remission Longer with Dose Adjustment and Monitoring

Infliximab Maintains IBD Remission Longer with Dose Adjustment and Monitoring

It is estimated that roughly 1.4 million Americans suffer from inflammatory bowel diseases (IBDs) such as Crohn’s disease and ulcerative colitis. Every year, over 30,000 new IBD diagnoses are made, and yet science has yet to determine this debilitating condition’s cause, nor has it found a reliable cure.

One of the drugs indicated for IBD, infliximab, was recently the subject of a study now published in the Inflammatory Bowel Diseases journal. In this observational study, conducted at the Beth Israel Deaconess Medical Center, the researchers recommended proactive monitoring and appropriate dose adjustment of the drug in order to enhance and prolong patients’ long-term therapeutic response.
Infliximab is an anti-tumor necrosis factor antibody. Specifically, it inhibits TNF-alpha — a protein found in abnormally high amounts in IBD patients and those with other inflammatory diseases. More popularly referred to with its brand name, Remicade, this drug is 1 of only 4 approved anti-TNF formulations indicated for cases unresponsive to or have built tolerance to traditional therapies.

While this medication has proven to be quite effective in producing and sustaining IBD remission, the body soon experiences a reduction in therapeutic response due to its suspected tendency to form antibodies against infliximab. This is a particularly disturbing outcome as this drug is normally given to patients as a sort of “last resort” for when they stop responding to other treatments, and is meant to be taken indefinitely to maintain remission.

Five years ago, lead author of the study and one of the doctors at BIDMC, Adam S. Cheifetz, MD, employed proactive monitoring on IBD patients receiving infliximab with the end goal of reducing incidences of toxicity and eventual development of tolerance. This same monitoring and dose adjustment was used in this pilot study.

48 participants were enrolled in the study. Those who were monitored and had their infliximab doses adjusted accordingly revealed a significant improvement in overall long-term sensitivity to the drug compared to those who received the standard regimen, who were noted to be thrice as likely to be taken off the medication. This suggests infliximab serum concentrations must be maintained within a certain therapeutic range in order to prevent the body from forming antibodies against it.

In other IBD news, scientists from Harvard discovered that a diet comprised of mostly meat may be a factor behind the development of inflammatory bowel disease and other gastrointestinal conditions.

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