Proactive infliximab is more effective than vedolizumab in inducing fecal calprotectin remission in inflammatory bowel disease
Creators: name: Fernandes, Samuel Raimundo
name: Rodrigues, Inês Coelho
name: Serrazina, Juliana
name: Botto, Inês Ayala
name: Bernardo, Sónia
name: Gonçalves, Ana Rita
name: Valente, Ana
name: Santos, Paula Moura
name: Correia, Luís Araújo
name: Marinho, Rui Tato
Publisher: name: Taylor & Francis
Year: 2022
Subjects: subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: Cell Biology
subject: Pharmacology
subject: Biotechnology
subject: 39999 Chemical Sciences not elsewhere classified
subject: FOS: Chemical sciences
subject: Ecology
subject: Immunology
subject: FOS: Clinical medicine
subject: 69999 Biological Sciences not elsewhere classified
subject: Cancer
subject: Science Policy

description: Current evidence suggests vedolizumab (VDZ) may be as effective as Infliximab (IFX) in inflammatory bowel disease. It is unknown if proactive therapeutic drug monitoring (PTDM) of IFX may improve these results. Case-control study including consecutive patients with primary response to conventional IFX (<i>n</i> = 70), proactive IFX (<i>n</i> = 148), and VDZ (<i>n</i> = 95). PTDM was performed at week 14 and every other infusion, aiming at a trough level between 5 and 10 µg/ml. The primary outcome was fecal calprotectin (Fc) remission (&lt;250 µg/g) at 1 year of treatment. Secondary outcomes included Fc remission at week 14 (proactive IFX/VDZ), clinical remission, treatment discontinuation, hospitalization, and surgery at 1-year of follow-up. Proactive IFX was superior to conventional IFX and VDZ in inducing Fc remission at 1-year (69.4% vs 47.1% vs 37.9%, <i>p</i> = .003 and <i>p</i> &lt; .001). Results remained significant in biologic naïve patients (70.8% vs 44.4% vs 51.4%, <i>p</i> = .001 and <i>p</i> = .043) but comparisons between conventional IFX and VDZ were not significant (<i>p</i> = .265 and <i>p</i> = .664). In multivariate analysis correcting for prior biologic exposure, proactive IFX was more effective than conventional IFX (OR 2.480 95%CI [1.367–4.499], <i>p</i> = .003) and VDZ (OR 3.467 95%CI [1.578–7.617], <i>p</i> = .002) in inducing Fc remission. Amongst secondary outcomes, only clinical remission was significant between proactive IFX and VDZ in the overall cohort (80.4% vs 55.8%, <i>p</i> &lt; .001) and in biologic naïve patients (80.2% vs 62.9%, <i>p</i> = .043). Fc remission at 1-year was associated with better results in most secondary outcomes. Proactive IFX was superior to VDZ in inducing Fc remission at 1-year, which was associated with improved clinical outcomes.SUMMARYCurrent evidence suggests that vedolizumab may be as effective as Infliximab in the treatment of patients with inflammatory bowel disease.There have been no studies comparing vedolizumab with proactively optimized Infliximab based on trough levels.We confirm that conventional IFX is as effective as vedolizumab but proactive IFX appears superior to vedolizumab in inducing fecal calprotectin remission.Fecal calprotectin remission associates with better clinical outcomes. Current evidence suggests that vedolizumab may be as effective as Infliximab in the treatment of patients with inflammatory bowel disease. There have been no studies comparing vedolizumab with proactively optimized Infliximab based on trough levels. We confirm that conventional IFX is as effective as vedolizumab but proactive IFX appears superior to vedolizumab in inducing fecal calprotectin remission. Fecal calprotectin remission associates with better clinical outcomes.