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Synopsis According to a report in The New England Journal of Medicine, the development of antibodies against infliximab is associated with an increased risk of infusion reactions and a reduced duration of response to treatment, whilst concomitant immunosuppressive therapy reduces the magnitude of the immunogenic response. Researchers evaluated a cohort of 125 consecutive patients with Crohn's disease who were treated with infliximab infusions. They analysed concentrations of infliximab and of antibodies against infliximab, clinical data, side effects including infusion reactions ; , and the use of concomitant medications before and 4, 8, and 12 weeks after each infusion. A mean of 3.9 infusions range, 1 to 17 ; per patient were administered over a mean period of 10 months. They reported that: Antibodies against infliximab were detected in 61% of patients. The presence of concentrations of 8.0 g per milliliter or greater before an infusion predicted a shorter duration of response 35 days, as compared with 71 days among patients with concentrations of less than 8.0 g per milliliter; P 0.001 ; and a higher risk of infusion reactions relative risk, 2.40; 95%CI, 1.65 to 3.66; P 0.001 ; . Infliximab concentrations were significantly lower at four weeks among patients who had had an infusion reaction than among patients who had never had an infusion reaction median, 1.2 vs. 14.1 g per milliliter; P 0.001 ; . Patients who had infusion reactions had a median duration of clinical response of 38.5 days, as compared with 65 days among patients who did not have an infusion reaction P 0.001 ; . Concomitant immunosuppressive therapy was predictive of low titers of antibodies against infliximab P 0.001 ; and high concentrations of infliximab four weeks after an infusion P 0.001.
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