We read with great interest the study by Li Wai Suen et al,1 investigating the role of therapeutic drug monitoring (TDM) of infliximab (IFX) in acute severe ulcerative colitis (ASUC). The authors demonstrate that early IFX serum levels and clearance correlate with outcomes of IFX rescue therapy in ASUC, with lower day-3 IFX levels predicting treatment failure and colectom, and high IFX clearance associated with nonresponse under standard dosing. Notably, the authors conclude that high drug clearance, which is a pharmacokinetic parameter that reflects severe inflammation and protein loss, may be overcome by intensified dosing.
We read with great interest the study by Li Wai Suen et al,1 investigating the role of therapeutic drug monitoring (TDM) of infliximab (IFX) in acute severe ulcerative colitis (ASUC). The authors demonstrate that early IFX serum levels and clearance correlate with outcomes of IFX rescue therapy in ASUC, with lower day-3 IFX levels predicting treatment failure and colectom, and high IFX clearance associated with nonresponse under standard dosing. Notably, the authors conclude that high drug clearance, which is a pharmacokinetic parameter that reflects severe inflammation and protein loss, may be overcome by intensified dosing.