Infliximab in inflammatory bowel disease

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Anti-tumor necrosis factor (TNF) therapy, with infliximab as the first agent, has transformed inflammatory bowel disease (IBD) treatment.
• Infliximab demonstrates significant efficacy and a favorable safety profile in moderate to severe IBD, pouchitis, and post-operative Crohn's disease (CD).

Purpose of the Study:

• To review the efficacy of infliximab in treating inflammatory bowel diseases (IBD).
• To discuss challenges such as lack of clinical benefit and loss of response to infliximab therapy.
• To highlight the role of therapeutic drug monitoring and the advent of infliximab biosimilars.

Main Methods:

• Review of randomized controlled trials, observational cohort studies, postmarketing registries, and meta-analyses.
• Analysis of data on infliximab's efficacy, safety, and management of treatment response in IBD.
• Focus on factors influencing treatment outcomes, including drug concentrations and antibody development.

Main Results:

• Infliximab is highly effective for moderate to severe IBD, with good safety.
• Up to 30% of patients may not benefit initially, and 50% can lose response over time.
• Inadequate drug levels and anti-infliximab antibodies contribute to treatment failure.

Conclusions:

• Therapeutic drug monitoring is crucial for managing and preventing loss of response to infliximab.
• Infliximab biosimilars offer comparable efficacy and safety to the originator.
• Optimizing infliximab therapy through monitoring and considering biosimilars improves patient outcomes in IBD.