title: Infliximab concentration monitoring improves the control of disease activity in rheumatoid arthritis.
abstract: BACKGROUND
  Adjustment of infliximab dosage for individuals may be useful in improving therapeutic response in rheumatoid arthritis (RA). Herein, we aimed to determine whether measurement of infliximab serum concentration modifies the therapeutic decision and improves the control of disease activity.
  
  
  METHODS
  RA patients routinely treated with infliximab were included in an observational open-label study. On visit 1 (V1), according to the disease activity, a preliminary therapeutic decision was selected among four therapeutic options and a blood sample was collected to measure trough serum infliximab concentration. The final therapeutic decision, based on both disease activity and serum infliximab concentration assessed at V1, was applied at the following infusion (V2). Clinical and biological evaluations were performed at V3 and V4 and compared with those at V1.
  
  
  RESULTS
  We included 24 patients. The final therapeutic decision differed from the preliminary decision for 12 patients (50%). For patients with increased infliximab dosage at V2, mean disease activity score for 28 joints (DAS28) decreased by about 20% at V3 or V4 as compared with V1 (P < 0.05). Decreased DAS28 was correlated with increased serum infliximab concentration (P < 0.02).
  
  
  CONCLUSIONS
  The measurement of infliximab trough concentration modifies the therapeutic decision for RA patients and helps improve control of disease activity. Therapeutic drug monitoring of infliximab in RA may be useful for individual dosage adjustment.
authors: Université François-Rabelais de Tours, 3 rue des Tanneurs, 37041 Tours Cedex 1, France. mulleman@med.univ-tours.fr
authors: Denis
authors: D
authors: Mulleman
authors: Jean-Camille
authors: JC
authors: Méric
authors: Gilles
authors: G
authors: Paintaud
authors: Emilie
authors: E
authors: Ducourau
authors: Charlotte
authors: C
authors: Magdelaine-Beuzelin
authors: Jean-Pierre
authors: JP
authors: Valat
authors: Philippe
authors: P
authors: Goupille
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000097:blood*; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000097:blood*; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy*; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab