Original articleAlimentary tractWithdrawal of Immunomodulators After Co-treatment Does Not Reduce Trough Level of Infliximab in Patients With Crohn’s Disease
Section snippets
Patients
In this retrospective analysis we included 223 patients with Crohn's disease who were treated with infliximab maintenance therapy12 at the University Hospitals Leuven. Serum samples were collected prospectively in all patients (Figure 1). All patients had given informed consent to the VLECC registry (biobank containing serum, DNA, and clinical characteristics of IBD patients). In our hospital, infliximab treatment is traditionally started as a combination treatment with immunomodulator except
Patient Characteristics
One hundred fifty-eight patients (71%) were co-treated with immunomodulators, and 65 patients were treated with infliximab monotherapy from the start. Immunomodulators were dosed according to the ECCO guidelines.2 One hundred seventeen of 158 patients (74%) in the combination strategy withdrew immunomodulator (85 azathioprine/6-mercaptopurine, 32 methotrexate) after a median of 13 months (IQR, 8–23) and continued infliximab monotherapy afterwards. Eighty percent of patients (126 of 158) in the
Discussion
The results of this study are in concordance with an earlier study from our group4 and indicate that withdrawal of immunomodulator after at least 6 months of combination treatment can be considered in patients with Crohn's disease treated with infliximab scheduled maintenance therapy, provided they have detectable trough levels at the time of immunomodulator withdrawal. The most striking observation in this study was the fact that none of the 27 patients with infliximab trough levels >5 μg/mL
Acknowledgments
The authors thank Jestinah Mahachie for her input to the statistical analysis.
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Conflicts of interest These authors disclose the following: David Drobne has received lecture fees and consultancy from MSD, Abbott, and Pfizer. Matthias Jürgens has received lecture fees from Schering–Plough Pharma. Marc Ferrante has received lecture fees and consultancy from MSD. Ann Gils has received lecture fees from MSD. Severine Vermeire is a member of speakers bureau for Schering-Plough. Paul Rutgeerts and Gert Van Assche have received research support and consultancy and are members of speakers bureau for Janssen and MSD. The remaining authors disclose no conflicts.