Navigation Links
Proactive monitoring of inflammatory bowel disease therapy could prolong effectiveness

BOSTON Proactive monitoring and dose adjustment of infliximab, a medication commonly used to treat inflammatory bowel disease (IBD), could improve a patient's chances of having a long-term successful response to therapy, a pilot observational study at Beth Israel Deaconess Medical Center concludes.

The study, published in the Inflammatory Bowel Diseases, evaluated the levels of infliximab, an antibody designed to bind to and block the effects of TNF-alpha, an inflammatory protein found in high levels in patients with IBD, such as Crohn's disease and ulcerative colitis, and numerous other inflammatory conditions such as rheumatoid arthritis and psoriasis. More commonly known as Remicade, infliximab is one of four anti-TNF agents used to treat these inflammatory diseases when they do not respond to or are intolerant of conventional therapies.

Infliximab has a good record of inducing and maintaining remission of IBD in patients with moderate to severe disease. But the therapy has not proven durable in treatment, primarily, researchers believe, because of the body's formation of antibodies to the medication. Only two-thirds of patients initially respond to infliximab and at one year less than half of the patients remain in remission. Additionally, it is estimated that 10 percent of patients on infliximab will lose response to the drug each year. This is significant because it is often prescribed with the expectation that patients will remain on it indefinitely.

Proactive therapeutic monitoring of a drug is common in other clinical scenarios, including solid organ transplant. In 2009, with that standard in mind, BIDMC attending physician Adam S. Cheifetz, MD began monitoring infliximab levels in his IBD patients with the goal of gradually adjusting their dosing regimens to hopefully improve long-term efficacy and decrease toxicity.

The pilot observational study of 48 patients found proactive monitoring of infliximab concentrations resulted in a significantly better chance of continuing on therapy than in patients who received the standard treatment and dosing regimen. The main reasons for this seemed to be less disease recurrence and fewer infusion reactions in the group that underwent proactive trough concentration monitoring. The authors hypothesize that maintaining a target infliximab concentration prevents the formation of antibodies to the therapy, which are implicated in loss of response to the drug and infusion reactions.

"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 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."

Cheifetz noted "this would be a huge paradigm shift for patients on IFX. Instead of just weight based dosing with empiric dose escalation for symptoms, we propose monitoring the serum drug concentrations and adjusting the dose to achieve a drug concentration within the therapeutic range."

The next step, he said, is verifying this with prospective studies as well as creating a pathway or algorithm for a provider to follow when prescribing IFX. This novel approach may have ramifications for other inflammatory diseases including rheumatoid arthritis and psoriasis, as well as for other biologic therapies (such as Humira) used to treat these conditions.


Contact: Jerry Berger
Beth Israel Deaconess Medical Center

Related medicine news :

1. SingleSource Background Screening Company Calls On Adults To Take Proactive Approach To Stop Child Sexual Abuse
2. Diabetes Support Supplements, a Product from ProactiveLife Celebrates First Year Launch
3. ProActive Chiropractic Volunteering at the Susan G. Komen Breast Cancer Walk
4. Dr. Andrew Cohen of ProActive Chiropractic Recaps the 2013 Chiropractic Sports Sciences Symposium
5. High Bit Security: 2/3 of All Data Breaches Preventable With Proactive Security Testing, New Ponemon Institute Study Documents Breach Causes and Costs
6. Triple Anti-Oxidant Liver Formula, a Proactive Approach to Dealing with Environmental Toxins, is Now Available for a Complimentary Trial
7. ZeptoMetrix Corporation (ZMC) in Collaboration with CytoSignet, Inc. to Offer Proactive, Patented* and Extensive Bed Bug Detection Products
8. Proactive Use of Florastor Probiotics Make for Happy, Healthy Holidays
9. Expanded Financial Options for Women Interested in Proactive Egg Freezing at Shady Grove Fertility
10. Proactive office ergonomics can increase job satisfaction and employee retention
11. Role of Screening, Monitoring in Early Kidney Disease Unclear
Post Your Comments:
(Date:6/18/2019)... , ... June 18, 2019 , ... ... addressing unmet needs in the field of urology, today announced that Aaron Berger, ... UroLift® Center of Excellence. The designation recognizes that Dr. Aaron Berger has achieved ...
(Date:6/16/2019)... ... June 15, 2019 , ... Convoy of Hope continues to celebrate ... to helping those in need around the world. To date, Convoy has worked with ... Convoy’s work would not be possible without the dedication and generosity of churches, organizations, ...
(Date:6/14/2019)... , ... June 14, 2019 , ... This past Saturday, ... and their dedicated support staff hosted the Parma Heights Day of Giving, where members ... about the event through local nonprofits that partnered with the Smiles for Everyone ...
(Date:6/13/2019)... ... June 13, 2019 , ... ... Second Test (BL30SEC) has been accepted by the 2019 National Conference of Interstate ... N requirements. , The Charm BL30SEC test was validated by third party ...
(Date:6/13/2019)... , ... June 13, 2019 , ... ... is proud to present the second annual Women|Future Conference and the ... allow attendees to better position themselves and their organizations in tomorrow's marketplace. , ...
Breaking Medicine News(10 mins):
(Date:6/20/2019)... ... June 20, 2019 , ... Phlexglobal today announced an important ... The guidance took effect on June 6, 2019, and promises to have far-reaching impacts ... departments and systems. , At 17 pages and going into specific detail – unusual ...
(Date:6/19/2019)... ... June 19, 2019 , ... Mahendra Kumar Trivedi has ... Physical Properties of Biofield Treated Bile Salt and Proteose Peptone became a No. ... Medicine, Biochemistry, Medical Technology, Pathophysiology, Molecular Biology, Science Reference and 45-Minute Science and ...
(Date:6/19/2019)... ... June 19, 2019 , ... “We sometimes take out teeth for granted,” said Arroyo Grande ... seldom think about our teeth unless it’s baby’s first tooth, that first visit from the ... and have a very important role in our overall health. Each tooth is as unique ...
Breaking Medicine Technology: