TY - JOUR
T1 - Potential application of measuring serum infliximab levels in rheumatoid arthritis management
T2 - A retrospective study based on KURAMA cohort data
AU - Nakae, Kazuto
AU - Masui, Sho
AU - Yonezawa, Atsushi
AU - Hashimoto, Motomu
AU - Watanabe, Ryu
AU - Murata, Koichi
AU - Murakami, Kosaku
AU - Tanaka, Masao
AU - Ito, Hiromu
AU - Yokoyama, Kotoko
AU - Iwamoto, Noriko
AU - Shimada, Takashi
AU - Nakamura, Miyuki
AU - Denda, Masaya
AU - Itohara, Kotaro
AU - Nakagawa, Shunsaku
AU - Ikemi, Yasuaki
AU - Imai, Satoshi
AU - Nakagawa, Takayuki
AU - Hayakari, Makoto
AU - Matsubara, Kazuo
N1 - Publisher Copyright:
Copyright: © 2021 Nakae et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2021/10
Y1 - 2021/10
N2 - Infliximab (IFX) therapy has considerably improved the treatment of rheumatoid arthritis (RA). However, some patients still do not respond adequately to IFX therapy, or the efficacy of the treatment diminishes over time. Although previous studies have reported a relationship between serum IFX levels and therapeutic efficacy, the potential applications of IFX therapeutic drug monitoring (TDM) in clinical practice remain unclear. The purpose of this study was to investigate the potential applications of IFX TDM by analyzing a Japanese cohort database. Data were collected retrospectively from the Kyoto University Rheumatoid Arthritis Management Alliance cohort between January 1, 2011, and December 31, 2018. Serum IFX levels were measured using a liquid chromatography-tandem mass spectrometer. Out of the 311 RA patients that used IFX, 41 were eligible for the analysis. Serum IFX levels were significantly higher in responders than in non-responders. An optimal cut-off value was determined to be 0.32 μg/mL based on a receiver operating characteristic curve. At the IFX measurement point, a better therapeutic response was observed in the high IFX group (n = 32) than in the low IFX group (n = 9). Conversely, at the maximum effect point, when DAS28-ESR was the lowest between IFX introduction and measurement points, there were no differences in responder proportions between the low and high IFX groups. IFX primary ineffectiveness could be avoided with appropriate dose escalation without blood concentration measurement in clinical practice. In conclusion, IFX TDM could facilitate the identification of secondary non-responders and in turn, proper IFX use.
AB - Infliximab (IFX) therapy has considerably improved the treatment of rheumatoid arthritis (RA). However, some patients still do not respond adequately to IFX therapy, or the efficacy of the treatment diminishes over time. Although previous studies have reported a relationship between serum IFX levels and therapeutic efficacy, the potential applications of IFX therapeutic drug monitoring (TDM) in clinical practice remain unclear. The purpose of this study was to investigate the potential applications of IFX TDM by analyzing a Japanese cohort database. Data were collected retrospectively from the Kyoto University Rheumatoid Arthritis Management Alliance cohort between January 1, 2011, and December 31, 2018. Serum IFX levels were measured using a liquid chromatography-tandem mass spectrometer. Out of the 311 RA patients that used IFX, 41 were eligible for the analysis. Serum IFX levels were significantly higher in responders than in non-responders. An optimal cut-off value was determined to be 0.32 μg/mL based on a receiver operating characteristic curve. At the IFX measurement point, a better therapeutic response was observed in the high IFX group (n = 32) than in the low IFX group (n = 9). Conversely, at the maximum effect point, when DAS28-ESR was the lowest between IFX introduction and measurement points, there were no differences in responder proportions between the low and high IFX groups. IFX primary ineffectiveness could be avoided with appropriate dose escalation without blood concentration measurement in clinical practice. In conclusion, IFX TDM could facilitate the identification of secondary non-responders and in turn, proper IFX use.
UR - http://www.scopus.com/inward/record.url?scp=85117192198&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117192198&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0258601
DO - 10.1371/journal.pone.0258601
M3 - Article
C2 - 34644354
AN - SCOPUS:85117192198
SN - 1932-6203
VL - 16
JO - PLoS One
JF - PLoS One
IS - 10 October
M1 - e0258601
ER -