Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2021; 27(9): 886-907
Published online Mar 7, 2021. doi: 10.3748/wjg.v27.i9.886
Predictive value of blood concentration of biologics on endoscopic inactivity in inflammatory bowel disease: A systematic review
Wan-Ting Cao, Rong Huang, Ke-Fang Jiang, Xue-Hui Qiao, Jing-Jing Wang, Yi-Hong Fan, Yi Xu
Wan-Ting Cao, Rong Huang, Ke-Fang Jiang, Xue-Hui Qiao, Jing-Jing Wang, Yi-Hong Fan, Yi Xu, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Wan-Ting Cao, Rong Huang, Ke-Fang Jiang, Xue-Hui Qiao, Jing-Jing Wang, Yi-Hong Fan, Yi Xu, Zhejiang Provincial Key Laboratory of Gastrointestinal Diseases Pathophysiology, Hangzhou 310006, Zhejiang Province, China
Author contributions: Cao WT designed the research; Fan YH performed the research; Cao WT, Wang JJ, and Jiang KF analyzed the data; Cao WT, Huang R, and Qiao XH wrote the paper; Xu Y supervised the paper; all authors read the paper and approved the final manuscript.
Supported by The National Natural Science Foundation of China, No. 81473506; Zhejiang TCM Science and Technology Project, No. 2019ZA056, No. 2016ZA092, and No. 2021ZA057.
Conflict-of-interest statement: All the authors declare that they have no competing interests to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Hong Fan, MD, Associate Professor, Chief Doctor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. yhfansjr@163.com
Received: October 17, 2020
Peer-review started: October 17, 2020
First decision: December 13, 2020
Revised: December 25, 2020
Accepted: January 12, 2021
Article in press: January 12, 2021
Published online: March 7, 2021
Abstract
BACKGROUND

Although blood concentration of biologics is an important composition of disease management in inflammatory bowel disease (IBD) patients, complexity and uncertainty of biological management encourage many disputes in predicting the outcome of IBD patients through blood concentration of biologics.

AIM

To verify the predictive value of blood concentration of biologics on endoscopic inactivity in IBD patients under different situations.

METHODS

We searched PubMed/MEDLINE, Embase, and Web of Science up to May 2020 and identified IBD patients as the research cohort as well as the correlations between blood concentration of biologics and endoscopic inactivity in IBD patients as the research direction.

RESULTS

A total of 23 articles with 30 clinical studies and 1939 IBD patients were included. The predictive cut-off value of blood concentration of infliximab on mucosal healing should be 2.7-10.6 μg/mL in IBD. Blood concentration of infliximab reaching 5.0-12.7 μg/mL or more increased the probability of fistula healing/closure in perianal fistulizing Crohn's disease. Blood concentration of adalimumab reaching 7.2-16.2 μg/mL or more could predict mucosal healing in IBD. The predictive cut-off value of blood concentration of adalimumab on fistula healing/closure should be 5.9-9.8 μg/mL in perianal fistulizing Crohn's disease. Blood concentration of vedolizumab surpassing 25.0 μg/mL indicated mucosal healing in ulcerative colitis patients under maintenance therapy and the predictive cut-off value of blood concentration on mucosal healing or endoscopic remission under induction therapy in IBD could be 8.0-28.9 μg/mL.

CONCLUSION

Blood concentration of biologics should not be utilized to predict endoscopic inactivity of IBD independently due to discrepancies in clinical studies, whereas conducting therapeutic drug monitoring intensively contributes to precise therapy.

Keywords: Inflammatory bowel disease, Biological blood concentration, Endoscopic inactivity, Infliximab, Adalimumab, Vedolizumab

Core Tip: Deep remission is considered the primary endpoint of biological therapy in inflammatory bowel disease. However, it is still difficult to determine or predict whether inflammatory bowel disease (IBD) patients achieve deep remission or not. Although endoscopic examinations are widely accepted by gastroenterologists as the golden standard in evaluating disease states, the majority of IBD patients reject frequent invasive examinations. Hence, new methods for early prediction of therapeutic outcomes in IBD patients on biologics are brought forward by gastroenterologists. Blood concentration of biologics, one of the major monitoring indicators during biological therapy, exhibits enormous tendency to correlate with outcomes of IBD patients. Nonetheless, blood concentration of biologics is not a substitute for endoscopic examinations in detecting deep lesions. By contrast, the combination of blood concentration of biologics and endoscopic examinations is conducive to enhancing the accuracy of outcome prediction.