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Objective To evaluate the role of infliximab trough levels(IFX-TL)and C reactive protein(CRP)concentration in prediction secondary loss of response(LOR)to infliximab(IFX)in patients with Crohn′s disease(CD)during IFX maintenance therapy since 14 weeks after induced treatment.Methods From November 2015 to October 2016,43 CD patients received IFX treatment were enrolled.IFX was initially given at zero,two,and six weeks at 5 mg/kg as induced therapy,and then the same dose was given every eight weeks as long-term maintenance treatment.Serum IFX-TL and CRP concentration were measured at 14thweek after the first IFX injection.The disease activity of CD was assessed by the Harvey-Braddshaw index.According to the follow-up results,the enrolled patients were divided into LOR group and continuous response group,and then the differences in IFX-TL and CRP concentrations at the 14thweek after induced therapy were compared between two groups.Mann-Whitney U test and receiver operating characteristic(ROC)curve were performed for statistical analysis.Results After a median 54 weeks of follow-up,18(41.9%)of 43 CD patients achieved a sustained response to IFX therapy,while 11 patients(25.6%)were LOR to IFX therapy.At the 14thweek after induced therapy,serum IFX-TL of LOR group was 2.30 μg/mL(0.52 μg/mL,2.92 μg/mL),which was lower than that of continuous response group(5.10 μg/mL(3.54 μg/mL,9.34 μg/mL)),and the difference was statistically significant(Z= -3.236,P=0.001).The CRP concentration of LOR group was 3.10 mg/L (0.38 mg/L,21.70 mg/L),which was higher than that of continuous response group(0.51 mg/L(0.27 mg/L, 1.50 mg/L)),and the difference was statistically significant(Z= -1.732,P=0.015).The results of ROC curve analysis indicated that at 14thweek after induced therapy the area under curve(AUC)value of predictive role of serum IFX-TL and CRP level in LOR to IFX was 0.864(95% confidence interval(CI)0.728 to 0.999),sensitivities were 83.3% and 81.8%,specificities were 94.4% and 54.5%,cut-off values of accuracies were 3.115 μg/mL and 5.93 mg/L.Conclusion IFX-TL<3.115 μg/mL and CRP concentration>5.93 mg/L at 14thweek since IFX induced therapy might be used as effective predictors of LOR in CD patients during maintenance therapy.
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Background:With the extensive use of infliximab (IFX)in treatment of patients with Crohn's disease (CD),some of the patients had losing of response to IFX treatment. The specific mechanism is not clear yet,and may be related to the formation of antibodies to infliximab (ATI). However,there is no report on the positivity rate of ATI in China so far. Aims:To investigate the clinical effects of serum IFX trough levels (IFX-TLs)and ATI in CD patients treated with IFX. Methods:A total of 76 CD patients receiving IFX treatment from Jan. 2016 to Mar. 2017 at Shanghai Renji Hospital were enrolled. Serum IFX-TLs and ATI were detected. CD patients were divided into active stage group and remission group according to CDAI score,and serum IFX-TLs,ATI,C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR) levels were analyzed. Results:Of the 76 patients with CD,positive ATI was found in 2 patients (2. 6%). Forty-five (59. 2%)patients were in remission,while 31 (40. 8%)in active stage. No significant differences in IFX-TLs [2. 84 (1. 30,4. 96)μg/ mL vs. 4. 08 (1. 29,6. 72)μg/ mL,P =0. 484],ATI [8. 00 (5. 27,14. 89)ng/ mL vs. 7. 00 (4. 40, 25. 00)ng/ mL,P = 0. 454]were found between active CD and remission CD. Serum CRP,ESR levels were significantly increased in active CD than in remission CD (P = 0. 038,P = 0. 009). Logistic regression analysis showed that activity of CD was related to CRP (OR = 6. 082,95% CI:1. 348-27. 436,P = 0. 019),but not related to IFX-TLs,ATI and ESR (P > 0. 05). Conclusions:The activity of CD may be correlated with CRP,but not with IFX-TLs,ATI and ESR.
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Objective To evaluate the relationship between plasma imatinib and its effect in the treatment of chronic myeloid leukemia(CML). Methods Fifty-one CML patients were included in this study,who began taking imatinib from July 2005 to February 2008, with 34 cases of male, and 17 cases of female.Nine patients took imatinib at dose of 300 mg/d, 37 patients took imatinib at dose of 400 mg/d, and 5 patients took imatinib at dose of 600 mg/d. High-performance liquid chromatography was used to test imatinib plasma levels. Results The imatinib plasma levels was imatinib dose-related, and the imatinib plasma trough levels significantly varied between individuals[(342-4688)ng/ml]. The imatinib plasma levels was significant lower in 300 mg/d dose group [(1037±514) ng/ml] than 400 mg/d dose group [(2123±1016) ng/ml] (t =2.34, P =0.032),and the effective rate was 66.7 % (6/9) in 300 mg/d dose group, which was lower than 400 mg/d dose group of 89.19 % (33/37) (χ2=7.14, P =0.008). In 300 mg/d and 400 mg/d dose groups, 39 patients achieved effective treatment, and their imatinib plasma levels was significant higher than that of 7 patients who did not achieved effective treatment (t =2.25, P =0.037). The ROC curve results suggested that clinical treatment may be poor when the imatinib plasma level was lower than 1050 ng/ml (sensitivity was 84.6 %, specificity was 71.1 %).Conclusion The imatinib plasma levels was dose-related, and significantly varied between individuals.Clinical treatment effect may be poor when the imatinib plasma level was lower than 1050 ng/ml.