Infliximab Intensification Research Articles

P684 Using a pharmacokinetic simulation model to determine the optimal infliximab intensification strategy to address loss of response in inflammatory bowel disease

Abstract Background The optimal dose intensification strategy to address loss of response associated with low infliximab levels remains uncertain. Favorable associations between higher infliximab levels and objective endpoints imply that post-intensification trough and treatment targets may have utility. This simulation study aimed to identify intensification strategies capable of achieving post-intensification trough thresholds associated with aspirational treatment targets in Crohn’s disease (CD) and ulcerative colitis (UC). Methods A previously published infliximab pharmacokinetic model, applied to 200 simulated patients, identified those with subtherapeutic(<3.00mg/L) trough levels after 30-weeks of standard dosing, and subsequently applied ten dose intensification strategies (Figure 1) over a further 32 weeks. The proportion of simulations achieving infliximab trough thresholds associated with endoscopic remission (CD >9.7mg/L; UC >7.5mg/L) was the primary outcome, with clinical improvement (CD >7.0mg/L; UC >3.7mg/L) and perianal fistula healing (CD >10.1mg/L) representing secondary outcomes. Outcomes were stratified by intensity of dose intensification, with five deemed intensive (>10mg/kg 8-weekly). The impact of pre-intensification antibodies to infliximab (ATI) on post-intensification trough levels was also evaluated. Results The median pre-intensification infliximab trough level was 0.91mg/L (IQR 1.31). Intensive intensification strategies were more likely to achieve infliximab trough concentrations associated with endoscopic remission (UC: 34.76 v 10.56%, CD: 25.80 v 4.92%), clinical improvement (UC: 61.40 v 34.52%, CD: 39.58 v 12.12%) and perianal fistula healing (24.70 v 4.50%, all p<0.01) than standard intensification strategies (Figure 2). When controlling for cumulative (mg/kg) infliximab dose over 32 weeks, strategies that concurrently dose increased and interval shortened achieved the highest trough levels (all p<0.01). Patients simulated to have ATI prior to dose intensification had lower median infliximab trough levels at weeks 30/32 (3.38 mg/L, IQR 5.52 mg/L) compared to those without ATI (3.89 mg/L IQR 6.14 mg/L) across all dose intensification strategies (p=0.015). Conclusion This simulation-based analysis highlights the potential of using post-intensification trough level targets to guide dosing strategy and intensity. Combined high-dose, interval-shortened strategies appear to achieve higher infliximab levels, which may be important in the pursuit of stringent endpoints such as endoscopic remission and fistula healing. These findings require validation across real-world cohorts.

Maladie de Crohn métastatique ombilicale : une localisation exceptionnelle

IntroductionCutaneous manifestations of Crohn's disease are frequent and include metastatic lesions. These are separated from the digestive tract and affect particularly the limbs and major folds. Umbilical involvement is exceptional. Case reportA 93-year-old woman followed for 6 years for Crohn's disease, in remission on infliximab, 5mg/kg every 8 weeks, consulted for a fissured and painful omphalitis. Histology revealed epithelioid granulomas without necrosis in the dermis, leading to the diagnosis of umbilical cutaneous metastasis of Crohn's disease. Infliximab intensification every 6 weeks led to a positive outcome. ConclusionWe report a unique case of umbilical metastatic localization of Crohn's disease occurring during treatment with anti-TNF alpha. The diagnosis was based on skin biopsy and histology which found epithelioid granulomas without caseous necrosis.

Impact of infliximab therapeutic drug level monitoring on outcomes of patients with inflammatory bowel disease: A real-world experience from a Middle Eastern cohort

Background and study aimTherapeutic drug monitoring (TDM) through measurement of infliximab (IFX) trough levels and antibodies to infliximab (ATI) is performed to guide IFX intensification strategies and improve its efficacy. We conducted this study to explore the relationship between clinical and endoscopic/radiological remission and IFX and ATI levels in patients with inflammatory bowel disease (IBD) treated with IFX and to evaluate the appropriateness of treatment decision post TDM. Patients and methodsThis was a cross-sectional study of a cohort of adult patients with IBD. Serum IFX trough concentrations and ATI were measured. ResultsA total of 129 patients [104] with ulcerative colitis (UC) and 25 with Crohn’s disease (CD)] were included in this study, of whom 61.2% were men. The mean disease duration was 6.7 years, and 72% of patients with UC had extensive colitis. The mean serum IFX trough level was 4.1 µg/mL; the IFX trough levels were subtherapeutic in 75 patients (58%), therapeutic in 37 patients (29%), and supratherapeutic in 17 patients (13%). Positivity to ATI was found in 16 patients (12.4%). Only 43 patients (33.3%) underwent an appropriate change in therapy after TDM, patients with penetrating CD disease had low IFX levels and higher C-reactive protein levels at 12 months before TDM. ConclusionsPatients with IBD with therapeutic IFX levels tend to have increased endoscopic/radiological remission rates. However, an appropriate change in management based on TDM was absent in the majority of patients, potentially reflecting the need to have a dashboard to support and guide clinicians in decision-making.

Efficacy and safety of infliximab: A comparison with other biological disease-modifying anti-rheumatic drugs

Objectives: The intensification of infliximab (IFX) treatment, involving escalation of the dose and shortening of interval, was approved in Japan in July 2009. We consider IFX intensification therapy to be preferable for patients with treatment-resistant active rheumatoid arthritis (RA). We retrospectively compared the efficacy of IFX with that of other bDMARDs in methotrexate (MTX)-resistant patients.Methods: Patients who satisfied the following criteria were enrolled: (i) those who started bDMARDs between February 2011 and December 2016, and (ii) those who required bDMARDs after 180 d of MTX treatment. We compared 33 patients who had been treated with IFX (IFX group) and 146 who had received other bDMARDs treatment (non-IFX group).Results: IFX was administered at a dose of 6.98 mg/kg/8-week equivalent at 52 weeks. Clinical disease activity index clinical remission (CDAI-CR) was achieved in 49 of the 179 patients at 52 weeks and 13 of these 49 patients received IFX. Logistic regression analysis showed that treatment with IFX was an important variable for the achievement of CDAI-CR at 52 weeks (odds ratio 2.69, 95% confidence interval 1.13–6.42). The severity and frequency of adverse events did not differ.Conclusion: Intensification of IFX was effective and well tolerated for MTX resistant patients.

Circulating Cytokines and Cytokine Receptors in Infliximab Treatment Failure Due to TNF-α Independent Crohn Disease.

The inflammatory response at infliximab (IFX) treatment failure due to tumor necrosis factor (TNF)-α-independent Crohn disease activity is unknown.This is an exploratory, hypothesis-generating study based on samples collected in a clinical trial among patients failing conventional IFX dosages and treated with an intensified IFX regimen for 12 weeks. Patients with clinical response at week 12, as defined by a reduction of Crohn disease activity index by ≥70, were considered to suffer from nonimmune pharmacokinetic (PK) treatment failure (n = 18), and nonresponders had a presumed pharmacodynamic (PD) failure due to non-TNF-driven disease (n = 8). Patients failing IFX due to functional anti-IFX antibodies (n = 2) were excluded. The study population also comprised a group of 12 patients in long-term remission on IFX. A functional cell-based reporter gene assay was applied to measure IFX and anti-IFX antibodies. Circulating cytokines and cytokine receptors were assessed by enzyme-linked immunosorbent assay: granulocyte-macrophage colony-stimulating factor, interferon-γ, interleukin (IL)-1α, IL-1β, IL-1Ra, IL-6, IL-10, IL-12p70, soluble TNF receptor (sTNF-R) 1, sTNF-R2, IL-17A, and monocyte chemotactic protein 1.The IFX levels were similar between patients with IFX failure caused by nonimmune PK or PD at treatment failure (median 1.4 vs 2.4 μg/mL; P = 0.52), during treatment intensification (8.1 vs 5.6; P = 0.85), and after 12 weeks (8.8 vs 7.7; P = 0.93), congruent with nonresponders failing IFX due to predominantly TNF-α-independent signaling pathways in their disease. Cytokine and cytokine receptor levels were comparable between patients with nonimmune PK failure and PD failure at time of manifestation of IFX failure, but with higher IL-6 and sTNF-R2 levels among IFX treatment failures as compared with patients in remission (IL-6 median 3.6 vs <3.1 pg/mL; P = 0.03; sTNF-R2 3207 vs 2547 pg/mL; P = 0.01). IL-6 and sTNF-R2 were lower after 12 weeks in nonimmune PK failures than in PD failures (<3.1 vs 4.0; P = 0.02; 3209 vs 4740; P = 0.04, respectively), and were measured at levels comparable with patients in remission. Further, trends of decreased IL-6 and sTNF-R2 levels among nonimmune PK failures during IFX intensification (P < 0.05 and P = 0.12) were observed.These observations indicate that IL-6 and sTNF-R2 are of potential relevance in driving the inflammatory response in IFX refractory Crohn disease caused by TNF-α-independent disease activity.

Sa1269 Adjunctive Allopurinol in Azathioprine/6-Mercaptopurine Non-Responders Optimises 6-Thioguanine Nucleotide Production and Improves Clinical Outcomes in Inflammatory Bowel Disease: The Prospective, Multicentre, Double Blind, Dose-Ranging AAA Study

Background: Infliximab (IFX) treatment failure in patients with Crohn's disease is generally handled by intensifying the IFX regimen. However, an alternative strategy defined by an algorithm based on serum IFX and anti-IFX antibody measurements to identify reasons for failure and corresponding interventions has been proposed. In a randomized controlled trial, we observed substantial cost reductions after 12 weeks when using this algorithm as compared to IFX intensification, and without negative influence on symptom control.(1) The current study primarily investigated long-term cost outcomes at time of the week 20 follow-up study visit and after 1 year. In addition, clinical outcomes were assessed at week 20. Methods: Predefined follow-up from a 12-week, single-blind, clinical trial where Crohn's disease patients with IFX treatment failure (CDAI ≥220 or ≥1 draining perianal fistula) were randomized to IFX intensification (5 mg/kg every 4 weeks) (n=36), or algorithm-defined interventions in form of IFX intensification, change to adalimumab, or use of pharmaceuticals other than TNF-inhibitors (n=33). Patients were treated at the discretion of the physician from week 12 onwards. Blinding was maintained until week 20. Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry. Data were analyzed in the following populations: intention-to-treat (ITT) (n=69), per protocol (PP) (n=55), per protocol completion at end of trial week 12 (PPCw12) (n=45) or end of followup week 20 (PPCw20) (n=29). NCT00851565. Results: At the scheduled follow-up study visit at week 20, response (CDAI reduction ≥70 point or ≥50% reduction of active fistulas) and remission rates (CDAI ≤150 or closure of all fistulas) were similar in all study populations between patients treated by the algorithm or by IFX intensification (p>0.05). However, the sum of health care costs related to Crohn's disease was substantially lower (31%) for patients randomized to algorithm-based interventions than IFX intensification in the ITT population: $10,815 vs. $15,613; p<0.01. In the PP and PPw12 populations, costs at week 20 were even lower (49% and 50%) in the algorithm group: $7,919 vs. $15,613; p<0.01; and $7,714 vs. $15,455; p<0.01. In the PPCw20 population, costs were reduced by 60% in algorithmtreated patients: $6,391 vs. $16,101; p<0.001. The observed relative cost reductions (i.e. percentages) remained stable from week 20 until reassessment after one year, and were similar also when evaluating total health care costs irrespective of relation to Crohn's disease. Conclusion: Economic benefit of algorithm-based interventions at IFX failure is maintained throughout one year. (1) Steenholdt et al. Gut (2014)

Sa1268 Individualized Therapy Is Long-Term Cost-Effective Compared to Dose Intensification in Crohn's Disease Patients Failing Infliximab

Background: Infliximab (IFX) treatment failure in patients with Crohn's disease is generally handled by intensifying the IFX regimen. However, an alternative strategy defined by an algorithm based on serum IFX and anti-IFX antibody measurements to identify reasons for failure and corresponding interventions has been proposed. In a randomized controlled trial, we observed substantial cost reductions after 12 weeks when using this algorithm as compared to IFX intensification, and without negative influence on symptom control.(1) The current study primarily investigated long-term cost outcomes at time of the week 20 follow-up study visit and after 1 year. In addition, clinical outcomes were assessed at week 20. Methods: Predefined follow-up from a 12-week, single-blind, clinical trial where Crohn's disease patients with IFX treatment failure (CDAI ≥220 or ≥1 draining perianal fistula) were randomized to IFX intensification (5 mg/kg every 4 weeks) (n=36), or algorithm-defined interventions in form of IFX intensification, change to adalimumab, or use of pharmaceuticals other than TNF-inhibitors (n=33). Patients were treated at the discretion of the physician from week 12 onwards. Blinding was maintained until week 20. Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry. Data were analyzed in the following populations: intention-to-treat (ITT) (n=69), per protocol (PP) (n=55), per protocol completion at end of trial week 12 (PPCw12) (n=45) or end of followup week 20 (PPCw20) (n=29). NCT00851565. Results: At the scheduled follow-up study visit at week 20, response (CDAI reduction ≥70 point or ≥50% reduction of active fistulas) and remission rates (CDAI ≤150 or closure of all fistulas) were similar in all study populations between patients treated by the algorithm or by IFX intensification (p>0.05). However, the sum of health care costs related to Crohn's disease was substantially lower (31%) for patients randomized to algorithm-based interventions than IFX intensification in the ITT population: $10,815 vs. $15,613; p<0.01. In the PP and PPw12 populations, costs at week 20 were even lower (49% and 50%) in the algorithm group: $7,919 vs. $15,613; p<0.01; and $7,714 vs. $15,455; p<0.01. In the PPCw20 population, costs were reduced by 60% in algorithmtreated patients: $6,391 vs. $16,101; p<0.001. The observed relative cost reductions (i.e. percentages) remained stable from week 20 until reassessment after one year, and were similar also when evaluating total health care costs irrespective of relation to Crohn's disease. Conclusion: Economic benefit of algorithm-based interventions at IFX failure is maintained throughout one year. (1) Steenholdt et al. Gut (2014)

Tu1285 Relationship Between Measures of Infliximab Exposure and Clinical Outcome of Infliximab Intensification At Therapeutic Failure in Crohn's Disease

Tu1285 Relationship Between Measures of Infliximab Exposure and Clinical Outcome of Infliximab Intensification At Therapeutic Failure in Crohn's Disease

Tu1284 Characterisation of Inflammatory Phenotype in Crohn's Disease Patients Refractory to Infliximab Intensification at Therapeutic Failure

Tu1284 Characterisation of Inflammatory Phenotype in Crohn's Disease Patients Refractory to Infliximab Intensification at Therapeutic Failure

Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab

In Crohn's disease patients failing infliximab therapy, interventions defined by an algorithm based on infliximab and anti-infliximab antibody measurements have proven more cost-effective than intensifying the infliximab regimen. This study investigated long-term economic outcomes at the week 20 follow-up study visit and after 1 year. Clinical outcomes were assessed at week 20. Follow-up from a 12-week, single-blind, clinical trial where patients with infliximab treatment failure were randomized to infliximab intensification (5 mg/kg every 4 weeks) (n = 36), or algorithm-defined interventions (n = 33). Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry. At the scheduled week 20 follow-up study visit, response and remission rates were similar in all study subpopulations between patients treated by the algorithm or by infliximab intensification. However, the sum of healthcare costs related to Crohn's disease was substantially lower (31 %) for patients randomized to algorithm-based interventions than infliximab intensification in the intention-to-treat population: $11,940 versus $17,236; p = 0.005. For per-protocol patients (n = 55), costs at the week 20 follow-up visit were even lower (49 %) in the algorithm group: $8,742 versus $17,236; p = 0.002. Figures were similar for patients having completed the 12-week trial as per protocol (50 % reduction in costs) (n = 45). Among patients continuing the allocated study intervention throughout the entire 20-week follow-up period (n = 29), costs were reduced by 60 % in algorithm-treated patients: $7,056 versus $17,776; p < 0.001. Cost-reduction percentages remained stable throughout one year. Economic benefit of algorithm-based interventions at infliximab failure is maintained throughout 1 year.

P501. Relationship between measures of infliximab exposure and clinical outcome of infliximab intensification at therapeutic failure in Crohn's disease

P501. Relationship between measures of infliximab exposure and clinical outcome of infliximab intensification at therapeutic failure in Crohn's disease

Changes in serum trough levels of infliximab during treatment intensification but not in anti-infliximab antibody detection are associated with clinical outcomes after therapeutic failure in Crohn's disease.

Intensification of the infliximab (IFX) regimen is recommended if the treatment effect is inadequate. However, the rationale for this is not well defined as the underlying mechanisms vary. The aim of this study was to explore the association between changes in serum IFX and anti-IFX antibodies (Abs) after IFX intensification and clinical outcomes. We performed a post hoc analysis of a randomized clinical trial including 42 Crohn's disease patients with IFX treatment failure, all treated with an intensified IFX regimen (5mg/kg every 4 week) for 12 weeks. Trough serum IFX and anti-IFX Ab concentrations were measured by a homogeneous mobility shift binding assay (HMSA) and a functional cell-based reporter gene assay (RGA) at treatment failure and the end of the trial. Twenty-one patients (50%) regained clinical response on the intensified IFX regimen. The increase in serum trough levels of IFX during treatment intensification was higher among responders than non-responders (RGA, 8.8 versus 3.0 μg/mL, p = 0.035; HMSA, 9.9 versus 4.7 μg/mL, p = 0.040), and differentiated patients by clinical outcome (RGA, area under receiver operating characteristic curve [AUC] 0.75 [0.53-0.97], p = 0.035; HMSA, AUC 0.74 [0.53-0.95], p = 0.042). All responders exhibited an IFX increase ≥2.6 μg/mL (sensitivity 100%, specificity 50%). Anti-IFX Abs detected by HMSA in 13 patients (32%) were often non-functional and became undetectable during IFX intensification. However, even functional anti-IFX Abs detected by RGA in six patients (15%) became undetectable. Increase in IFX levels following treatment intensification was associated with improved clinical outcomes, indicating insufficient drug levels in a subgroup of patients. Anti-IFX Abs may become undetectable during treatment intensification, suggesting lowered production or the formation of immune complexes.

Long-term efficacy of infliximab for refractory ulcerative colitis: results from a single center experience.

BackgroundThe long-term efficacy of infliximab (IFX) for patients with refractory ulcerative colitis (UC) is unclear. The aim of this study was to assess the long-term outcomes of IFX treatment in patients with refractory UC.MethodsThirty-three patients with refractory UC who received IFX treatment at Kyoto University Hospital between 2003 and 2013 were retrospectively evaluated. IFX intensification was defined as a dose escalation (up to 10 mg/kg) and/or shorter intervals between infusions (every 4–6 weeks).ResultsOf the 33 patients who received scheduled infusions of IFX, 24 (72.7%) achieved clinical remission within 8 weeks after initiating IFX treatment. Of these 24 responders, 17 (70.8%) experienced a relapse of UC and required IFX intensification, and 16 (66.7%) eventually maintained clinical remission with IFX treatment, including IFX intensification. Of the 33 patients, 6 (18.2%) underwent colectomy during IFX treatment. Multivariate regression analysis showed that a serum C-reactive protein (CRP) concentration <5 mg/L two weeks after starting IFX was a predictor of a positive clinical response to IFX induction therapy. No severe adverse events occurred in UC patients treated with IFX.ConclusionIFX intensification was necessary for long-term maintenance of remission and to prevent colectomy in patients with refractory UC.

Concomitant use of enteral nutrition therapy is associated with sustained response to infliximab in patients with Crohn’s disease

A significant proportion of Crohn's disease (CD) patients receiving infliximab (IFX) maintenance therapy show loss of responsiveness despite a good initial response. The factors other than immunomodulators that prevent IFX dose escalation have yet to be fully elucidated. This study was performed to identify clinical factors or concomitant therapies associated with sustained response to IFX. Seventy-four consecutive CD patients who had successful IFX induction therapy between 2002 and 2010 underwent IFX maintenance therapy. Patients showing loss of response to IFX were treated with IFX intensification therapy. Factors involved in the sustained response to IFX were investigated retrospectively. After a median follow-up of 85 weeks, loss of response to IFX was observed in 30 (40.5%) cases. On logistic regression analysis, concomitant use of enteral nutrition (EN) therapy (elemental and/or polymeric formulas) was identified as an independent factor associated with sustained response to IFX. Receiver operating characteristic curve analysis indicated a cutoff value of 600 kcal/day. We divided the patients into the 'EN group' (≥ 600 kcal/day) and 'control group' (<600 kcal/day). The cumulative number of loss of response was significantly lower in the EN group (odds ratio: 0.23, P = 0.0043). Kaplan-Meier analysis confirmed the significantly lower rate of loss of response in the EN group (P = 0.013). Multivariate hazard ratio was 0.37 (P = 0.025). Type of EN formula did not affect the results. Concomitant use of EN ≥ 600 kcal/day is likely to yield a sustained response to IFX in CD patients.

P353 MMX® a mesalazine and long-term safety: A pooled analysis

the need for and timing of infliximab dose escalation in two cohorts of patients with CD or UC. Methods: In this single-center study, dose intensification was determined by two senior staff specialized in IBD. We compared the rates of patients and of patients-months on infliximab who needed infliximab dose intensification (either by increasing the dose to 10mg/kg or by shortening the dosing interval) in the cohorts of CD or UC patients. We also compared the interval between infliximab first induction dose and the first escalated infliximab dose. Intensification-free survival was estimated by the Kaplan Meier method. Results: We evaluated 61 patients with CD (mean age 42 years; 54% female) and 41 patients with UC (mean age 44 years; 41% female). Three in four CD patients vs 83% UC patients (p = 0.38) were receiving an immunomodulator when infliximab is initiated. After a median follow-up of 12.5 months (IQR, 7 23 months) and 8.5 months (IQR, 5 13 months) for CD or UC patients, respectively, 16/61 (26%) of CD patients required infliximab intesification vs 16/41 (39%) of UC patients (p = 0.16). The likelihood of needing infliximab intensification per patient-month on infliximab was 1.5% vs 3.9% (p < 0.001) for CD and UC, respectively. In patients who underwent infliximab optimization, median time between the first infliximab induction dose and the first escalated dose was 10.5 (IQR, 8.7 15.2) months vs 6.2 (IQR, 3.5 8.3) months (p = 0.02) for CD and UC, respectively. Survival curves showed that patients with UC had an increased probability of needing infliximab dose intensification when compared with CD patients. Conclusions: The likelihood of needing infliximab dose intensification is higher in UC patients when compared with CD patients. Patients with UC required intensification of infliximab dosing earlier and infliximab intensification-free survival was also lower in these patients.

W1127 Intensification of Infliximab (IFX) Therapy in Crohn's Disease: Efficacy and Safety

W1127 Intensification of Infliximab (IFX) Therapy in Crohn's Disease: Efficacy and Safety

P157 - Intensification of infliximab (IFX) therapy in Crohn's disease: efficacy and safety

P157 - Intensification of infliximab (IFX) therapy in Crohn's disease: efficacy and safety

Impact of Three Anti-TNFα Biologics on Existing and Emergent Autoimmunity in Rheumatoid Arthritis and Spondylarthropathy Patients

The objective of this study was to analyze the effects of 3 anti-TNFalpha agents on markers of autoimmunity in rheumatoid arthritis (RA) and spondylarthropathy (SPA) patients. First-time anti-TNFalpha biologics (infliximab, etanercept, or adalimumab) were prescribed to 156 RA and 95 SPA (58 ankylosing spondylarthritides, 37 psoriatic arthritides). During 1-2 years of follow-up, clinical, biological [antinuclear (ANA) and anti-double-stranded (dsDNA) antibodies, rheumatoid factors (RF), and anti-cyclic citrullinated peptide (CCP) for RA], and therapeutic data were collected biannually. ANA appeared or ANA and anti-dsDNA titers increased significantly (P < 0.001) more under infliximab than etanercept in both rheumatisms and than adalimumab in RA patients. During the 2-year follow-up, ANA appeared more in RA patients taking adalimumab than etanercept (P = 0.003), but independently of the anti-TNFalpha used; anti-dsDNA titers rarely became positive. Under etanercept or infliximab, ANA and anti-dsDNA were not influenced by the underlying pathology nor were they affected by infliximab intensification over 18 months. Only one case of cutaneous lupus was observed in a patient having IgG anti-dsDNA. The therapeutic responses were independent of ANA and anti-dsDNA titers for all rheumatisms and biologics. In RA patients, RF titers, but not anti-CCP levels, declined with the therapeutic response for all biologics. This is the first study that has evaluated the impact of three TNFalpha blockers on ANA and anti-dsDNA antibodies in RA and SPA patients. Autoimmunity was more induced with infliximab than etanercept and to a lesser degree to adalimumab but, more importantly, this emergent autoimmunity was exceptionally associated to clinical manifestations of lupus.

W1249 Intensification of Infliximab (Ifx) Therapy in Crohn's Disease: Efficacy and Safety

W1249 Intensification of Infliximab (Ifx) Therapy in Crohn's Disease: Efficacy and Safety