1. Utility of Therapeutic Drug Monitoring for Tumor Necrosis Factor Antagonists and Ustekinumab in Postoperative Crohn’s Disease
- Author
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Yushan Pan, Waseem Ahmed, Prerna Mahtani, Rochelle Wong, Randy Longman, Dana Jeremy Lukin, Ellen J Scherl, and Robert Battat
- Subjects
Biological Products ,Treatment Outcome ,Crohn Disease ,Tumor Necrosis Factor-alpha ,Adalimumab ,Gastroenterology ,Humans ,Immunology and Allergy ,Ustekinumab ,Tumor Necrosis Factor Inhibitors ,Drug Monitoring ,Infliximab - Abstract
Background In postoperative Crohn’s disease (POCD), data are lacking on relationships between serum biologic concentrations and treatment outcomes. We assessed if established threshold concentrations of infliximab (IFX), adalimumab (ADA), and ustekinumab (UST) impact outcomes in POCD. Methods Data were extracted from POCD patients with serum biologic concentration measurements using Weill Cornell Medicine biobanks. The primary outcome compared rates of deep remission (achieving both objective [endoscopic or biomarker] and clinical [Harvey-Bradshaw index or Crohn’s Disease Patient Reported Outcome-2] remission), using established serum drug level cutoffs of IFX ≥3 µg/mL, ADA ≥7.5 µg/mL, and UST ≥4.5 µg/mL. Results In 130 patients, median IFX, ADA, and UST concentrations were 10 (interquartile range [IQR], 2.9-26.9) µg/mL, 10.5 (IQR, 4.9-14.9) µg/mL, and 6.9 (IQR, 5.1-10.2) µg/mL, respectively. In patients with IFX ≥3 µg/mL, higher rates of deep remission (39% vs 0%; P = .02) existed compared with those with IFX Conclusions In POCD, established anti-tumor necrosis factor concentrations were associated with improved outcomes. No relationship between UST concentrations and postoperative outcomes existed.
- Published
- 2022