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Infliximab serum trough levels reliable for adjusting therapy in patients with RA
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Low infliximab serum trough levels were common and reliable among stable patients with rheumatoid arthritis, even those with low disease activity, and may allow for scaled back therapy, according to recent study data.
Dutch researchers conducted a longitudinal, observational study of 147 patients with rheumatoid arthritis to determine the reliability of infliximab serum trough levels and anti-infliximab antibodies in the cohort. Trough levels were considered low (<1 mg/L) and high (>5 mg/L), and Disease Activity Score 28 (DAS28) was defined as low (≤3.2), high (>3.2) or disease remission (≤2.6).
At baseline patients (mean age, 58 years; 69% women) displayed mean DAS28 of 3.5, had treated with infliximab for at least 6 months and had mean disease duration of 11 years. Twenty-seven percent of patients had DAS28 less than 2.6 (95% CI, 20%-34%) and that grew to 44% of patients when DAS28 was 3.2 or lower (95% CI, 36%-52%). Follow-up was conducted across 1.5 years and 1,320 visits.
At first study visit, low infliximab serum trough levels were common among 48% of patients with high DAS28 (95% CI, 37%-59%). Researchers, however, also found low trough levels among patients with low disease activity (31%; 95% CI, 20%-42%), while 14% of patients (95% CI, 5-22) had high trough levels. One-third of all patients (95% CI, 26%-41%) also displayed detectable anti-infliximab antibodies during at least one visit.
“Our study demonstrated that measuring infliximab serum trough levels and anti-infliximab antibodies during the maintenance phase of infliximab treatment could be of value to optimize treatment,” the researchers wrote. “Since infliximab serum trough levels and anti-infliximab antibodies are reliable measurements, these might be used to identify patients in whom infliximab can be de-escalated or stopped.”
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