Estudo do nível sérico de Infliximabe e de Adalimumabe e de seus anticorpos no manejo do tratamento de pacientes com doenças inflamatórias intestinais

Abstract

The aim of the treatment of patients with Inflammatory Bowel Diseases is to control the inflammatory response to maintain clinical and endoscopic remission with healing of the mucosa. It seems that monitoring serum levels of biological drugs and their antibodies may allow physicians to optimize treatment and keep drugs in effective concentrations for longer, as well as having a significant impact on the cost of treating these patients. Our aim was to validate the importance of serum levels of anti-TNF-α drugs and their antibodies in the clinical management of patients with IBD, correlating with three types of clinical evolution: sustained clinical response, loss of response and non-response to the use of drug, in addition to correlate with clinical, demographic, laboratory and imaging parameters. A cross-sectional study of 95 patients with CD or UC was performed on maintenance therapy with infliximab or adalimumab. The trough levels of drugs and anti-drug antibodies were determined by ELISA tests. In the present study there was no statistically significant difference between drug levels and their antibodies and the clinical responses presented by the patients. Regarding the serum infliximab dosage, we found that patients with higher CRP levels had significantly lower serum infliximab levels (<3 μg / ml) (p = 0.028). On the other hand, higher concentrations of anti-IFX antibodies were found in patients who were not on concomitant immunomodulators (p = 0.022), in patients who had biological-related adverse events (p = 0.001) and higher levels of CRP (p = 0.042). Serum CRP levels were also negatively correlated with IFX (CC = -0.315; p = 0.033), but positively correlated with the presence of IFX antibodies (CC = 0.327; p = 0.027). Serum albumin dosage showed a positive correlation with serum infliximab levels (CC = 0.379, p = 0.004) and adalimumab (CC = 0.699, p = 0.003). In conclusion, although anti-TNF-α trough levels and immunogenicity do not show a significant correlation with disease outcomes, results reinforce the use of combination therapy for patients under infliximab. Moreover, we confirmed the presence of significant associations of anti-TNF-α trough levels and immunogenicity with BMI, concomitant use of immunomodulators, rates of side effects, and also laboratory markers including serum albumin and CRP.