[Main therapeutic advances in IBD in 2007]

Area of Science:

• Immunology
• Gastroenterology
• Rheumatology

Background:

• Three biological agents targeting TNFalpha were expected in 2008.
• The combination of infliximab and azathioprine was previously used but is now discouraged.
• Concerns arose regarding hepatosplenic lymphomas associated with infliximab and azathioprine combination therapy.

Purpose of the Study:

• To evaluate the efficacy of regular maintenance therapy with infliximab.
• To compare maintenance therapy with co-administration of infliximab and an immunomodulator in preventing anti-infliximab antibodies.
• To explore the role of residual drug levels in therapeutic benefit.

Main Methods:

• Observational analysis of patients receiving infliximab therapy.
• Comparison of antibody development in patients on maintenance therapy versus combination therapy.
• Assessment of trough levels of infliximab between infusions.

Main Results:

• Regular maintenance therapy with infliximab is as effective as using an immunomodulator in preventing anti-infliximab antibodies.
• The combination of infliximab and azathioprine is associated with a poor prognosis for hepatosplenic lymphomas.
• Residual trough levels of infliximab between perfusions appear beneficial.

Conclusions:

• Regular maintenance therapy with infliximab is a viable strategy to prevent antibody formation.
• The combination of infliximab with azathioprine should be avoided due to severe adverse events.
• Maintaining consistent infliximab levels may be key to long-term efficacy and preventing immunogenicity.