Higher infliximab trough levels are associated with perianal fistula healing in patients with Crohn's disease

• Published in: Alimentary pharmacology & therapeutics 2017-04, Vol.45 (7), p.933-940
• Main Authors: Yarur, A. J., Kanagala, V., Stein, D. J., Czul, F., Quintero, M. A., Agrawal, D., Patel, A., Best, K., Fox, C., Idstein, K., Abreu, M. T.
• Format: Article
• Language: English
• Subjects: Adult; Crohn Disease - blood; Crohn Disease - drug therapy; Crohn's disease; Cross-Sectional Studies; Demographic variables; Demographics; Demography; Dose-Response Relationship, Drug; Female; Fistulae; Humans; Immunotherapy; Infliximab; Infliximab - blood; Infliximab - pharmacokinetics; Infliximab - therapeutic use; Male; Middle Aged; Monoclonal antibodies; Mucosa; Rectal Fistula - blood; Rectal Fistula - drug therapy; Treatment Outcome; Tumor necrosis factor-α; Wound Healing - drug effects; Young Adult
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13970

Summary Background Infliximab has been found to be efficacious in the treatment of fistulas in the setting of Crohn's disease, even though some patients do not benefit from therapy. Aim To assess the correlation between perianal fistula healing and trough levels of infliximab. Methods In this cross‐sectional study, we identified patients with Crohn's disease who had perianal fistulas and were treated with infliximab for at least 24 weeks. We excluded patients who underwent a faecal diversion procedure or proctectomy. Predictive variables included demographics, disease phenotype, disease activity, infliximab levels, anti‐infliximab antibodies. The primary outcome was fistula healing defined as the absence of drainage. The secondary outcome was complete fistula closure and mucosal healing. Results 117 patients were included. Patients with fistula healing had significantly higher median serum infliximab levels when compared to those with active fistulas [15.8 vs. 4.4 μg/mL, respectively (P