Poster (15W192)

The use of Anti-TNF levels and antibodies for precise tailoring of inflammatory bowel disease (IBD) treatment

Author(s)

H. Naqvi, S. Anwar, A. O’Toole, G. Harewood, Prof. S. Patchett

Department(s)/Institutions

Department of Gastroenterology, Beaumont Hospital, Department of Immunology, Beaumont Hospital

Introduction

The use of anti tumour necrosis factor (anti-TNF) drugs has dramatically improved the management of inflammatory bowel disease (IBD). The cost of long term treatment with these biological agents coupled with their long term efficacy in maintaining remission has introduced new concepts of tailoring anti-TNF therapy. The symptom profile along with use of drug levels and anti-drug antibodies provides more insight into the disease and immunological status. This approach therefore helps for precise tailoring of IBD treatment.

Aims/Background

We considered retrospective analysis of clinical and laboratory data of IBD patients who had anti-TNF levels and/or antibodies tested since 2012. These patients had treatment tailored accordingly therefore we aimed to review the impact of these tests on clinical decision making.

Method

Retrospective data was collected and analysed on 54 patients attending Beaumont Hospital, Gastroenterology services. These patients had anti-TNF tests tested for following indications

1- To optimize IBD treatment in deteriorating patients
2- To consider possibility of less frequent dosing in stable patients
3- Other reasons in stable IBD patients

Results

A total of 54 patients analyzed were on biological treatment at the time of testing. Ulcerative colitis was the diagnosis of 21 patients whereas 30 patients had crohn’s disease. The remaining 3 patients had indeterminate colitis.

Three patients with stable IBD had test done for rheumatologic or skin disorders 2 of them continued the same treatment. Two patients with stable disease had levels tested to consider less frequent dosing but were continued on 6 weekly infliximab as levels were borderline.

One patient was found to have duodenal malignancy. Four had worsening symptoms requiring surgical intervention. Thirteen patients with normal/borderline drug levels had symptom improvement on follow up assessments therefore no change was made to their management.

Thirty one (57.40%) patients had treatment changed on the basis of tests. Twelve were changed from infliximab to Adalumimab and 1 to Golimumab due to presence of antibodies. Twelve patients on infliximab and 3 on Adalumimab had low drug levels without antibodies therefore managed with dose escalation of same anti- TNF agent. Three patients are being considered for anti-integrin treatment as one had multi drug antibodies and 2 had complete failure to multiple anti-TNF agents.

Conclusions

Recent clinical data and our retrospective observational data support the concept of testing anti-TNF levels and antibodies in order to optimize the IBD treatment. This approach can also prove cost effective as it may prevent unnecessary use of anti-TNF agents especially where formed antibodies will render trial of dose escalation completely useless.