Mucosal healing in Crohn’s requires higher Remicade levels postinduction
Patients with Crohn’s disease need higher levels of Remicade to promote mucosal healing during the postinduction phase of treatment, according to results of a retrospective study.
Ren Mao, MD, of the department of gastroenterology at The First Affiliated Hospital of Sum Yat-sen University in China, and colleagues wrote that previous studies have linked anti-TNF, including Remicade (infliximab, Janssen), and mucosal healing. However, these studies normally only looked at the maintenance phase.
“The clinical practice in our center, where most patients undergo routine endoscopic assessment at weeks 14 and 30 of biologic therapy, allowed for an opportunity to explore in a real-life cohort the correlation between [mucosal healing] and drug levels at two clinically important standardized time points, which has been scantly investigated by prior studies,” they wrote.
Researchers performed a retrospective study of patients with CD treated with infliximab in a tertiary referral center between 2012 and 2018 (n = 289), and they investigated the link between therapy and mucosal healing — defined as absence of ulceration by endoscopy — at weeks 14 and 30. Investigators included data from 141 patients at week 14 and 109 patients at week 30.
Mao and colleagues found that median drug levels were higher in patients with mucosal healing at weeks 14 (7.5 vs. 1.5 g/mL; P < .001) and 30 (5.9 vs. 0.5 g/mL; P < .001). Patients with mucosal healing at week 14 had higher drug levels compared with patients with mucosal healing at week 30 (7.5 vs. 5.9 g/mL; P < .05).
Researchers were able to use an infliximab level above 2.85 g/mL to identify patients with mucosal healing at week 30, while they needed a level above 4.85 g/mL to identify patients with mucosal healing at week 14.
“Notably, the [infliximab] concentration threshold for [mucosal healing] postinduction was higher than that during the maintenance phase in CD patients, which may imply that patients at different time points require different [infliximab] trough levels to accomplish the treatment goal — [mucosal healing],” Mao and colleagues concluded. – by Alex Young
Disclosures: Mao reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.