Clinical utility of measuring infliximab and human anti-chimeric antibody concentrations in patients with inflammatory bowel disease.
Clinical utility of measuring infliximab and human anti-chimeric antibody concentrations in patients with inflammatory bowel disease.
复制标题
DOI：
10.1038/ajg.2010.9
复制
发表时间：
2010-05
期刊：
影响因子：
--
通讯作者：
Sandborn WJ
中科院分区：
文献类型：
--
作者：
Afif W;Loftus EV Jr;Faubion WA;Kane SV;Bruining DH;Hanson KA;Sandborn WJ
人类抗嵌合抗体(Hacas)和亚治疗性英夫利昔单抗的浓度与反应持续时间的缩短有关。我们评估了测量HACA和英夫利昔单抗浓度的临床实用性。回顾炎症性肠病(IBD)患者进行HACA和英夫利昔单抗浓度测定的病历，以确定这一结果是否影响临床治疗。对155名患者进行了HACA和英夫利昔单抗浓度测定。测试的主要适应症是对英夫利昔单抗的反应丧失(49%)，英夫利昔单抗启动后的部分反应(22%)，以及可能的自身免疫/迟发型超敏反应(10%)。35名患者(23%)检测到Hacas，51名患者(33%)检测到治疗性英夫利昔单抗浓度。在评估的177项测试中，73%的结果影响了治疗决定。在HACA阳性患者中，更换另一种抗肿瘤坏死因子(TNF)药物与92%的患者完全或部分有效相关，而剂量递增的有效率为17%。在低于治疗浓度的患者中，86%的患者剂量增加与完全或部分临床反应有关，而改用另一种抗肿瘤坏死因子药物的患者有33%的反应。有临床症状和治疗性英夫利昔单抗浓度的患者76%的时间继续服用相同剂量的药物，62%的时间通过内窥镜/放射评估没有活动性炎症的证据。HACA和英夫利昔单抗浓度的测量影响管理，并在临床上有用。对于患有Hacas的患者，增加英夫利昔单抗剂量是无效的，而对于浓度低于治疗性英夫利昔单抗的患者，这一策略可能是更换另一种抗肿瘤坏死因子药物的良好替代方案。
Human anti-chimeric antibodies (HACAs) and subtherapeutic infliximab concentrations are associated with decreased duration of response. We evaluated the clinical utility of measuring HACA and infliximab concentrations. The medical records of patients with inflammatory bowel disease (IBD) who had HACA and infliximab concentrations measured were reviewed to determine whether the result affected clinical management. One hundred fifty-five patients had HACA and infliximab concentrations measured. The main indications for testing were loss of response to infliximab (49%), partial response after initiation of infliximab (22%), and possible autoimmune/delayed hypersensitivity reaction (10%). HACAs were identified in 35 patients (23%) and therapeutic infliximab concentrations in 51 patients (33%). Of 177 tests assessed, the results impacted treatment decisions in 73%. In HACA-positive patients, change to another anti-tumor necrosis factor (TNF) agent was associated with a complete or partial response in 92% of patients, whereas dose escalation had a response of 17%. In patients with subtherapeutic infliximab concentrations, dose escalation was associated with complete or partial clinical response in 86% of patients, whereas changing to another anti-TNF agent had a response of 33%. Patients with clinical symptoms and therapeutic infliximab concentrations were continued at the same dose 76% of the time and had no evidence of active inflammation by endoscopic/radiographic assessment 62% of the time. Measurement of HACA and infliximab concentration impacts management and is clinically useful. Increasing the infliximab dose in patients who have HACAs is ineffective, whereas in patients with subtherapeutic infliximab concentrations, this strategy may be a good alternative to changing to another anti-TNF agent.
登录
查看更多内容
影响因子：
29.4
作者：
Farrell, RJ;Alsahli, M;Michetti, P
通讯作者：
Michetti, P
影响因子：
29.4
作者：
Colombel, Jean-Frederic;Sandborn, William J.;Pollack, Paul F.
通讯作者：
Pollack, Paul F.
影响因子：
24.5
作者：
Vermeire, Severine;Noman, Maja;Rutgeerts, Paul
通讯作者：
Rutgeerts, Paul
影响因子：
168.9
作者：
D'Haens, Geert;Baert, Filip;Hommes, Daniel
通讯作者：
Hommes, Daniel
DOI：
10.1038/ajg.2010.9
发表时间：
2010-05
期刊：
The American journal of gastroenterology
影响因子：
--
作者：
Afif W;Loftus EV Jr;Faubion WA;Kane SV;Bruining DH;Hanson KA;Sandborn WJ
通讯作者：
Sandborn WJ