Noninvasive Targeted Crohn Disease Management by Combining Endoscopic Healing Index and Therapeutic Drug Monitoring

Amy Hemperly, Marla C. Dubinsky, Andres Yarur, Anita Afzali, Stephen Hanauer, Subra Kugathasan, Millie D. Long, Shervin Rabizadeh, Robbyn Sockolow, Lauren Okada, Anjali Jain, Maria T. Abreu, Niels Vande Casteele*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background and Aims: Therapeutic drug monitoring (TDM) with measurement of serum drug and antidrug antibody concentrations is used to optimize tumor necrosis factor antagonists (anti-TNF). The endoscopic healing index (EHI) is a validated serum-based assay to measure mucosal inflammation in adults with Crohn disease (CD). Our objectives were to evaluate the relationship between EHI and TDM results and to determine the anti-TNF concentration range associated with EHI <20 (consistent with endoscopic remission). Methods: Adult and pediatric patients with CD (N = 1731) were selected retrospectively from a clinical laboratory cohort. Patients were selected if they had an ICD-10 code for CD and if results for EHI and TDM were available within 30 days of each other. The relationship between EHI and TDM results was examined and the anti-TNF concentration range associated with EHI <20 vs >50 was evaluated. Results: Median anti-TNF concentration was higher in patients with EHI <20 vs >50 for infliximab (N = 796): 11.1 vs 3.4 μg/mL and for adalimumab (N = 935): 9.2 vs 5.0 μg/mL (P < 0.0001 both drugs). Patients with antibodies to infliximab (12.8%) or adalimumab (14.9%) had lower anti-TNF concentrations (P < 0.001 both drugs) and higher EHI (P < 0.01 both drugs). The concentration range for infliximab: 5-15 μg/mL (5-9 μg/mL in pediatric patients) and for adalimumab: 5-10 μg/mL (8 μg/mL in pediatric patients) best discriminated EHI <20 vs >50. Conclusions: We report the anti-TNF concentration range associated with EHI <20. Combined testing of EHI and TDM is proposed as a noninvasive approach for treat-to-target management which could improve the ability to monitor disease and optimize anti-TNF therapy.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalCrohn's and Colitis 360
Volume3
Issue number3
DOIs
StatePublished - Jul 1 2021

Keywords

  • biomarker
  • endoscopic remission
  • inflammatory bowel disease
  • treat-to-target

ASJC Scopus subject areas

  • Gastroenterology

Fingerprint

Dive into the research topics of 'Noninvasive Targeted Crohn Disease Management by Combining Endoscopic Healing Index and Therapeutic Drug Monitoring'. Together they form a unique fingerprint.

Cite this