Brief Article
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World J Gastroenterol. May 7, 2014; 20(17): 5031-5035
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5031
Utility of serum TNF-α, infliximab trough level, and antibody titers in inflammatory bowel disease
Éva Pallagi-Kunstár, Klaudia Farkas, Zoltán Szepes, Ferenc Nagy, Mónika Szűcs, Róbert Kui, Rolland Gyulai, Anita Bálint, Tibor Wittmann, Tamás Molnár
Éva Pallagi-Kunstár, Klaudia Farkas, Zoltán Szepes, Ferenc Nagy, Anita Bálint, Tibor Wittmann, Tamás Molnár, First Department of Medicine, University of Szeged, H6720 Szeged, Hungary
Mónika Szűcs, Department of Medical Physics and Informatics, University of Szeged, H6720 Szeged, Hungary
Róbert Kui, Rolland Gyulai, Department of Dermatology and Allergology, University of Szeged, H6720 Szeged, Hungary
Author contributions: Farkas K, Wittmann T and Molnár T contributed to supervision of patient selection; Pallagi-Kunstár É, Farkas K, Szűcs M, Gyulai R, and Molnár T contributed to study design and statistical analysis; Pallagi-Kunstár É and Bálint A performed the ELISA measurements; Farkas K, Szepes Z, Nagy F, Kui R, Gyulai R, Bálint A and Molnár T, contributed to data collection and manuscript preparation; all authors approved the final draft for submission.
Supported by TAMOP-4.2.2.A-11/1/KONV-2012-0035, TAMOP-4.2.2-A-11/1/KONV-2012-0052 TAMOP-4.2.2.A-11/1/KONV-2012-0073; and OTKA Research Proposal PD 105948 (PI: Klaudia Farkas)
Correspondence to: Tamás Molnár, MD, PhD, First Department of Medicine, University of Szeged, Korányi fasor 8-10, H6720 Szeged, Hungary. molnar.tamas@med.u-szeged.hu
Telephone: +36-62-545186  Fax: +36-62-545185
Received: October 11, 2013
Revised: December 13, 2013
Accepted: January 8, 2014
Published online: May 7, 2014
Processing time: 208 Days and 4.2 Hours
Abstract

AIM: To assess tumor necrosis factor-α (TNF-α), infliximab (IFX) concentrations, and antibodies against IFX molecules in patients with inflammatory bowel disease (IBD) who develop loss of response, side effects, or allergic reaction during anti TNF-α therapy.

METHODS: Blood samples of 36 patients with response loss, side effects, or hypersensitivity to IFX therapy (Group I) and 31 patients in complete clinical remission (Group II) selected as a control group were collected to measure trough serum TNF-α level, IFX, and anti-IFX antibody (ATI) concentration. We examined the correlation between loss of response, the development of side effects or hypersensitivity, and serum TNF-α, IFX trough levels, and ATI concentrations.

RESULTS: The serum TNF-α level was shown to be correlated with the presence of ATI; ATI positivity was significantly correlated with low trough levels of IFX. ATIs were detected in 25% of IBD patients with loss of response, side effects, or hypersensitivity, however no association was revealed between these patients and antibody positivity or lower serum IFX levels. Previous use of IFX correlated with the development of ATI, although concomitant immunosuppression did not have any impact on them.

CONCLUSION: On the basis of the present study, we suggest that the simultaneous measurement of serum TNF-α level, serum anti TNF-α concentration, and antibodies against anti TNF-α may further help to optimize the therapy in critical situations.

Keywords: Tumor necrosis factor-α; Infliximab; Antibody; Inflammatory bowel disease

Core tip: The clinical utility of measuring serum tumor necrosis factor-α (TNF-α), infliximab, and anti-infliximab levels in the therapeutic decisions of patients with inflammatory bowel disease is still an outstanding question. In this study we assessed TNF-α, infliximab concentrations, and antibodies against infliximab molecules in patients with inflammatory bowel disease who developed loss of response, side effects, or allergic reaction during anti TNF-α therapy. Our results showed that the simultaneous measurement of serum TNF-α level, serum anti TNF-α concentration, and antibodies against anti TNF-α may further help to optimize therapy in critical situations.