Background Preliminary data suggest that treatment optimization can reverse immunogenicity and regain response in patients with IBD and secondary loss of response (SLR) to anti-TNF therapy due to antidrug antibodies. However, data regarding the long-term outcome of these patients are scarce. Aims We aimed to investigate drug retention in IBD patients of whom infliximab was optimized to overcome immunogenic - ity and variables associated with drug retention. Methods This was a retrospective, multicenter study of consecutive IBD patients with antibodies to infliximab (ATI), based on either proactive or reactive therapeutic drug monitoring, who underwent infliximab optimization (increasing dose, short - ening interval, adding an immunomodulator, or combination) to overcome immunogenicity from September 2012 to July 2015; they were followed through December 2015. ATI were analyzed using the drug-tolerant Prometheus homogeneous mobility shift assay. Drug retention was defined as no need for drug discontinuation due to SLR or serious adverse event. Results Our cohort consisted of 22 patients (Crohn’s disease, n = 15). At the end of follow-up [median, (IQR): 17.3 (10.5– 32.8) months] 77% (15/22) of patients were still on drug. Univariable Cox proportional hazards regression analysis identi- fied first detectable ATI titer as the only variable associated with drug retention (HR:
Digestive Diseases and Sciences – Springer Journals
Published: Jan 16, 2018
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