Assessment of infliximab and antibody to infliximab levels is desirable to guide therapy at the point of loss of response

▸ Steenholdt C, Brynskov J, Thomsen OØ, et al. Individualised therapy is more cost-effective than dose intensification in patients with Crohn's disease who lose response to anti-TNF treatment: a randomised, controlled trial. Gut 2014;63:919–27. This study, the first controlled trial comparing dose escalation of infliximab with a treatment algorithm based on drug and antidrug antibody levels in the context of loss of treatment response in Crohn's disease, demonstrates cost benefit and clinical equivalence of an algorithm based approach.

Infliximab (IFX), a human-mouse chimerical antitumour necrosis factor α (anti-TNFα) drug, is a mainstay of treatment of Crohn's disease (CD). Initial response to therapy is often good, but subsequent loss of response (LOR) is common with time. Given the lack of alternative treatments it is desirable to optimise anti-TNF therapy, if possible, to extend its duration of therapeutic effect. Dose escalation of IFX at the point of LOR has been shown to be effective in a percentage of patients, but also has cost and side-effect implications. Measurement of IFX and antibodies to IFX (ATI) levels can be …