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Development of Antibodies to Infliximab in IBD

Summary and Comment |
November 4, 2013

Development of Antibodies to Infliximab in IBD

  1. Douglas K. Rex, MD

Findings of a 4-year prospective study confirmed a longer time to development of antibodies with concomitant immunomodulator therapy than with infliximab alone.

  1. Douglas K. Rex, MD

Antibodies to infliximab are associated with loss of response in patients with inflammatory bowel disease (IBD). The incidence of anti-infliximab antibody development is lower in patients receiving concomitant immunomodulator therapy. To better understand that association as well as the evolution of anti-infliximab antibody development, investigators prospectively studied 125 patients with IBD (98 with Crohn disease and 27 with ulcerative colitis) who received infliximab therapy during a 4-year period.

Median follow-up was 11.5 months. At 4 years, 42% of patients remained free of anti-infliximab antibodies. Among patients who developed infliximab antibodies, 90% did so during the first 12 months of treatment. In survival analysis, time to development of anti-infliximab antibodies was significantly longer in patients who also received immunomodulator therapy than in patients who received infliximab alone (P=0.003). In 54% of patients, development of antibodies preceded onset of clinical loss of response (median lag time, 2 months).

Comment

Based on findings that antibodies tend to appear during the first year of infliximab therapy and that immunomodulator therapy reduces the risk for their development, early introduction of combination therapy in patients with inflammatory bowel disease is attractive for preventing antibody formation.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Exact Sciences; Ferring Pharmaceuticals; Given Imaging; Olympus Speaker’s bureau Boston Scientific; Braintree; Ferring Pharmaceuticals Grant / research support Battelle; Braintree; Northwestern University; Olympus America Editorial boards Annals of Gastroenterology and Hepatology; Comparative Effectiveness Research; Expert Review of Gastroenterology and Hepatology; Gastroenterology; Gastroenterology and Hepatology News; Gastroenterology Report; Gastroenterology Research and Practice; Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; World Journal of Gastroenterology; World Journal of Gastrointestinal Oncology; World Journal of Gastrointestinal Pathophysiology; World Journal of Gastrointestinal Pharmacology and Therapeutics

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