Preventing Fistulas and Improving Radiologic Remission with Infliximab

Two recent studies show how infliximab improves outcomes in Crohn’s disease.

The first study by Bossuyt et al was a substudy (n=36) of the TAILORIX trial. Key findings:

  • At week 54 of treatment, 36.4% of patients had a radiologic response, 30.3% of patients were in remission, and 71% had endoscopic features of remission
  • Radiologic remission correlated with infliximab trough level at week 14 (P = .049) when the infliximab trough level cut-off value was set at 7.8 μg/mL (area under the curve, 0.74; 75% sensitivity; 86% specificity; 90% negative predictive value; 57% positive predictive value)
  • Radiologic response was also associated with continuous infliximab trough levels above 5.0 μg/mL at all time points) (P = .034)
  • Among patients with both radiologic and endoscopic remission, the median infliximab trough level was 8.5
  • In this study, one interesting finding was that only half of patients with endoscopic remission achieved radiologic remission, especially since the cohort had a short disease duration at the onset of treatment (median duration of 1.5 months)

In the second study by Singer et al with 208 pediatric patients with Crohn’s disease, all patients had baseline cross-sectional imaging. Key findings:

  • 26% had perianal fistulas at baseline
  • 14/136 (10%) developed perianal fistulas within 3 years
  • Non-white race increased the risk of perianal fistula
  • Non-penetrating perianal lesions (NPLs) increased the risk of perianal fistulas (20% in patients with NPLs vs. 4% in those without NPLs)
  • Anti-TNF treatment was associated with a decreased risk of perianal fistulas (HR 0.11); this risk reduction was seen in patients with NPLs also (HR =0.14)
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My take: Good infliximab levels correlate with better outcomes.

Related blog posts:

And from The Onion:

1 thought on “Preventing Fistulas and Improving Radiologic Remission with Infliximab

  1. Yes, but the FDA just lowered dosing recommendations, leading to lots of denials. How did the infliximab community allow this to happen? Now that we have demonstrated that higher drug levels are needed for better outcomes, FDA lowered the dosing regimen and insurance companies are having a great time!

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