英夫利昔单抗谷浓度对炎症性肠病患者维持治疗 5 年持续临床缓解的预测价值。
Predictive value of infliximab trough levels in maintenance therapy for 5-year sustained clinical remission in patients with inflammatory bowel disease.
出版信息
Bratisl Lek Listy. 2023;124(7):485-492. doi: 10.4149/BLL_2023_074.
BACKGROUND
Despite long-term use of infliximab (IFX) in IBD treatment, its optimized use is unclear due to its complicated pharmacokinetics/dynamics. Hence, the predictive value of IFX trough levels (TL) is important in treatment management.
METHODS
We performed a prospective, cross-sectional, observational study with 74 IBD patients treated with IFX (mean 9.1 years, SD ± 3). TL was measured during maintenance therapy, in which maintenance of remission was followed for 5 years.
RESULTS
TL > 3 µg/ml during maintenance therapy was a significant predictor of clinical remission in 5 years in UC patients (82 % vs 62 %, p 3 µg/ml during maintenance therapy in a cohort of IBD patients (p = 0.05). Deviations in percentage of remission and fraction of relapses in TL categories were insignificant in a cohort of CD patients (85 % vs 74 %, p > 0.05).
CONCLUSIONS
TL > 3 µg/ml during maintenance therapy is a strong predictor of sustained clinical remission for 5 years in UC patients. The use of combination therapy with AZA, due to its significant association with high TL, may have a practical benefit in achieving better clinical outcomes in UC patients (Tab. 2, Fig. 10, Ref. 20).
背景
尽管英夫利昔单抗（IFX）在 IBD 治疗中的应用已有很长时间，但由于其复杂的药代动力学/药效动力学，其最佳使用方法仍不明确。因此，IFX 谷浓度（TL）的预测价值在治疗管理中很重要。
方法
我们进行了一项前瞻性、横断面、观察性研究，纳入 74 例接受 IFX 治疗的 IBD 患者（平均 9.1 年，SD ± 3）。在维持治疗期间测量 TL，维持缓解期为 5 年。
结果
在 UC 患者中，维持治疗期间 TL > 3 µg/ml 是 5 年内临床缓解的显著预测因素（82% vs 62%，p = 0.003）。在 IBD 患者队列中，维持治疗期间 TL > 3 µg/ml 与缓解率和复发率的百分比差异无统计学意义（85% vs 74%，p > 0.05）。
结论
在 UC 患者中，维持治疗期间 TL > 3 µg/ml 是 5 年内持续临床缓解的有力预测因素。联合使用 AZA 的治疗方案可能具有实用价值，因为它与较高的 TL 显著相关，可改善 UC 患者的临床结局（表 2，图 10，参考文献 20）。
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