- Fecal Incontinence
|Proactive therapeutic drug monitoring is more effective than conventional management in inducing fecal calprotectin remission in inflammatory bowel disease
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(12):15391546.doi:10.1097/MEG.0000000000002111.
Samuel Raimundo Fernandes 1, Juliana Serrazina, Inês Coelho Rodrigues, Sónia Bernardo, Ana Rita Gonçalves, Ana Valente, Cilénia Baldaia, Paula Moura Santos, Luís Araújo Correia, Rui Tato Marinho
1Department of Gastrenterology and Hepatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Background: Proactive therapeutic drug monitoring (pTDM) may improve treatment outcomes in inflammatory bowel disease.
Aims and methods: We compared 135 patients following a prospective pTDM protocol aiming at an infliximab trough level (IFXTL) between 5 and 10 μg/ml with sequential measurements of Fc, with 108 patients from a retrospective group under conventional management. We evaluated the rates of Fc remission (<250 μg/g) and other clinical outcomes at 2-year of follow-up.
Results: pTDM associated with higher rates of Fc remission (69.6% vs. 50.0%; P = 0.002), and steroid-free clinical remission (78.4% vs. 55.2%, P = 0.028) with a trend for clinical remission (79.3% vs. 68.5%, P = 0.075). There was no difference in treatment discontinuation (P = 0.195), hospitalization (P = 0.156), and surgery (P = 0.110). Higher IFXTL associated with Fc remission at week 14 (6.59 vs. 2.96 μg/ml, P < 0.001), and at the end of follow-up (8.10 vs. 5.03 μg/ml, P = 0.001). In patients reaching Fc remission after week 14, IFXTL increased from week 14 to the end of follow-up (2.71 vs. 8.54 μg/ml, P < 0.001). Fc remission associated with higher rates of clinical (85.8% vs. 56.8% P < 0.001) and steroid-free clinical remission (86.9% vs. 50.0% P < 0.001), lower IFX discontinuation (8.8% vs. 36.8%, P < 0.001), and hospitalization (13.5% vs. 33.7%, P < 0.001), without significance for surgery (6.1% vs. 12.6%, P = 0.101).
Conclusion: pTDM was more effective than conventional management in inducing Fc remission which was associated with improved outcomes.