Effect of Infliximab Dose Increase in XXXX at Different Trough Concentrations: A Cohort Study in Clinical Practice Conditions.

@entity1 @entity309
BACKGROUND: Evidence supporting treatment intensification in @entity309 ( @entity309 ) is limited and controversial. We explored outcomes of infliximab dose increases and accounted for pre-existing trough levels in @entity1 with active @entity309 . METHODS: This study was a retrospective study of 42 @entity309 @entity1 who received increased infliximab following an insufficient response (DAS28 >3.2). Serum concentrations of infliximab and antibodies to infliximab (ATI) and DAS28 and EULAR clinical response parameters were recorded for 1   year. Analyses were performed in three @entity1 groups that were defined by infliximab serum concentration prior to treatment enhancement: no detectable, low (<1.1    g/mL) or high (>= 1.1    g/mL) drug levels. RESULTS: No circulating infliximab was detected in 20 @entity1 (47.6%), but 13 (31%) and 9 (21.4%) @entity1 exhibited low and high levels, respectively. ATI was only detected in @entity1 with no detectable drug levels because the drug interferes with ELISA. DAS28 disease activity globally showed a modest improvement after dose escalation, but this improvement did not persist after 6 and 12   months. Infliximab serum levels increased significantly in the high group (p   =   0.016), but no increase was achieved in the low and no detectable groups. The three study groups exhibited similar disease activity over time, and no improvement was observed in the non-responder EULAR rates. CONCLUSION: These results suggest that the efficacy of an infliximab dose increase is limited, and the response is independent of the infliximab trough serum concentration that is achieved prior to escalation.
