Anti-tumor necrosis factor treatments have not had extensive research into the effects of early proactive therapeutic drug level monitoring. For patients with inflammatory bowel disease (IBD) on adalimumab, researchers wanted to see if the serum trough level at week 2 might predict clinical outcomes. Patients with inflammatory bowel disease who had a serum adalimumab level at week 2 were included in this retrospective analysis. The best threshold level for adalimumab at Week 2 was determined using receiver operating characteristic curve analysis. Clinical remission (CR) at week 12 and short-term endoscopic healing were compared between patients over the threshold. The correlation between adalimumab concentration in week 2 and CR were analyzed using multivariate logistic regression. A 2nd-week adalimumab level was taken from 46 patients. The area under the receiver operating characteristic curve for adalimumab at 11.9 mcg/mL indicated its effectiveness. About 3 times as many patients with adalimumab levels greater than 11.9 mcg/mL in week 2 achieved CR as those whose levels were lower than or equal to this threshold (odds ratio=3.34, 95% CI: 1.01-12.11, P=0.04). The analysis showed no significant correlation between the other covariates and the primary outcome. While patients with adalimumab week 2 levels above 11.9 mcg/mL did have a greater percentage of short-term endoscopic healing, this difference was not statistically significant (71.4% vs. 28.5%, P=0.11). Short-term CR appears to be predicted by serum adalimumab levels at week 2. Research is needed to determine if patients with an adalimumab level at week 2 of 11.9 mcg/mL or lower might benefit from starting on a lower dose.
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