Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · 2025
Overcoming anti-Infliximab antibodies and maintaining Infliximab achieves superior durability and outcome compared to switching to Adalimumab.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Granot Maya, Nachum Nurit, Krauthammer Alexander, Berger Tal David, Heiman Sophia, Yavzori Miri, Picard Orit, Ben-Horin Shomron, Weiss Batia, Haberman Yael
Аннотация
BACKGROUND AND AIMS: The development of antibodies to infliximab (ATI) is a major challenge in pediatric inflammatory bowel disease (IBD). This real-world study aimed to identify predictors of ATI, evaluate strategies to overcome ATI, and compare the durability of continuing infliximab (IFX) versus switching to adalimumab (ADA) after ATI development.
METHODS: We retrospectively analyzed 194 pediatric IBD patients treated with IFX from 2010 to 2024. ATI titers were measured uniformly before each infusion. Demographic data, disease characteristics, ATI titers, infusion reactions, management strategies, and treatment durability were collected and analyzed.
RESULTS: ATI developed in 52 of 194 patients (26.8 %), more frequently in Crohn's disease (31.2 %) than ulcerative colitis (16.1 %, p < 0.01), and was associated with female gender (57.7 % vs. 39.4 %, p = 0.03) and younger age at diagnosis. High-titer ATI (≥8 mcg/ml-eq) correlated with infusion reactions (56.5 % vs. 3.5 %, p < 0.001). ATI was managed with dose/interval adjustment (61.9 %), immunomodulator addition (16.7 %), or both (21.4 %). IFX continuation was successful in 71.4 %, especially in low-titer ATI (92.0 % vs. 41.2 %, p < 0.001). IFX durability after ATI was significantly longer (median 94 months) than ADA after switching (47 months, p < 0.01).
CONCLUSIONS: About 27 % of pediatric IBD patients developed ATI to IFX. Personalized management can restore IFX efficacy and provides superior long-term outcomes compared to switching to ADA.
METHODS: We retrospectively analyzed 194 pediatric IBD patients treated with IFX from 2010 to 2024. ATI titers were measured uniformly before each infusion. Demographic data, disease characteristics, ATI titers, infusion reactions, management strategies, and treatment durability were collected and analyzed.
RESULTS: ATI developed in 52 of 194 patients (26.8 %), more frequently in Crohn's disease (31.2 %) than ulcerative colitis (16.1 %, p < 0.01), and was associated with female gender (57.7 % vs. 39.4 %, p = 0.03) and younger age at diagnosis. High-titer ATI (≥8 mcg/ml-eq) correlated with infusion reactions (56.5 % vs. 3.5 %, p < 0.001). ATI was managed with dose/interval adjustment (61.9 %), immunomodulator addition (16.7 %), or both (21.4 %). IFX continuation was successful in 71.4 %, especially in low-titer ATI (92.0 % vs. 41.2 %, p < 0.001). IFX durability after ATI was significantly longer (median 94 months) than ADA after switching (47 months, p < 0.01).
CONCLUSIONS: About 27 % of pediatric IBD patients developed ATI to IFX. Personalized management can restore IFX efficacy and provides superior long-term outcomes compared to switching to ADA.