Relation between serum trough infliximab levels, pre- treatment CRP levels and clinical response to infliximab treatment in rheumatoid arthritis

Gerrit Jan Wolbink ^1*, Alexandre Voskuyl ², Willem Lems ³, Els de Groot ⁴, Michel T Nurmohamed ¹, Paul P. Tak ⁵, Ben A.C. Dijkmans ⁶ and Lucien Aarden ⁷

¹ Jan van Breemen Instituut The Netherlands
² Vu-medical Center The Netherlands
³ Slotervaart Hospital The Netherlands
⁴ Sanquin Research the Netherlands
⁵ Academic Medical Center/University of Amsterdam, The Netherlands
⁶ VU-medical Center The Netherlands
⁷ Sanquin Research The Netherlands

^* To whom correspondence should be addressed. E-mail: g.wolbink{at}janvanbreemen.nl.

Accepted 7 September 2004

Abstract

Objective:To investigate the relationship between serum trough infliximab levels and clinical response to infliximab therapy in patients with rheumatoid arthritis (RA).

Methods:We assessed disease activity and serum trough infliximab levels before and 2, 6 and 14 weeks after initiation of infliximab therapy at a dose of 3 mg/kg in a cohort of 105 RA patients. Serum trough infliximab levels were compared between responders and non-responders. Moreover we compared the clinical response of patients with high, intermediate and low serum trough infliximab levels at 14 weeks.

Results:After 14 weeks of treatment non- responders had lower serum trough levels of infliximab compared to responders (median [interquartile range]: 0.5 [0.2-2.2] versus 3.6 [1.4-8.2]mg/L; P < 0.01)]. Patients with low serum trough infliximab levels at 14 weeks had significant less improvement in DAS28 score compared to patients with intermediate or high serum trough infliximab levels at 14 weeks. Pre-treatment CRP levels correlated negatively with serum trough infliximab levels at 14 weeks after start of treatment (Spearman rank correlation r = -0.43 P < 0.001).

Conclusion:Serum trough levels of infliximab correlate with the clinical response to treatment with infliximab and pre- treatment CRP levels. The results of the present study indicate that patients with high pre-treatment CRP levels might benefit from higher dosages of infliximab or shorter dosing intervals.

Keywords: C reactive protein, DAS28, infliximab, rheumatoid arthritis

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