A multicenter prospective cohort study of patients with Crohn's disease found that patients who received high concentrations of anti-tumor necrosis factor therapy were linked to a greater probability of sustained remission, Medscape Medical News reported Oct. 1.
The findings come from a two-year extension of the original one-year personalized anti-TNF therapy in Crohn's disease study conducted in the United Kingdom, but was also noted by researchers in the U.S., including Miguel Reguiero, MD, chief of the Digestive Diseases Institute at the Cleveland Clinic.
"This is one of the more important studies looking at the longitudinal care of patients with Crohn's disease on infliximab and adalimumab," said Dr. Regueiro in the report.
The study included 955 patients treated with inflixmab and 655 treated with adalimumab between March 2014 and September 2017. Researchers found that anti-drug antibiotics and undetectable drug levels were associated with both treatment without and accompany immunomodulator and carriage of the HLA-DQA1*05 genetic risk factor, though the latter was only true for treatment with inflixmab.
Dr. Reguiero noted that the study ultimately shows the importance of treating Crohn's "right in induction," highlighting a debate among clinicians about whether higher drug levels are associated with remission due to the effects of the higher doses or because those patients have leakiness in the gut, resulting in higher protein therapeutics retention.