Differential Serum-intestinal Dynamics of Infliximab and Adalimumab in Inflammatory Bowel Disease Patients

Haggai Bar-Yoseph, Alexandra Blatt, Shiran Gerassy, Sigal Pressman, Amjad Mousa, Edmond Sabo, Matti Waterman, Bella Ungar, Shomron Ben-Horin, Yehuda Chowers*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and Aims: Therapeutic drug monitoring is used to guide anti-tumour necrosis factor [TNF] therapy. However, the associations between serum drug levels [SDL], TNF-bound, and free anti-TNF in the target tissue are incompletely defined. We aimed to assess the interactions between these parameters in inflammatory bowel disease [IBD] patients. Methods: Enzyme-linked immunosorbent assays [ELISA assays] were used to detect free drug and TNF-drug complexes in intestinal tissues. Concurrent SDL, anti-drug antibodies [ADA], pharmacotherapy, clinical response, endoscopic appearance, and histological severity were determined. Comparisons between anti-TNFs and paired inflamed/non-inflamed tissue were performed. Variables were correlated and potential interactions detected using multivariate analysis. Results: A total of 95 biopsies taken from 49 anti-TNF treated IBD patients [26 receiving infliximab and 23 adalimumab] were studied. Free drug levels were higher in inflamed compared with non-inflamed paired specimens. Tissue free-drug and TNF-drug complexes levels were higher in adalimumab-treated patients. In adalimumab-treated patients, SDL were correlated with free drug, but not TNF-drug complex levels, in both inflamed and non-inflamed segments. In infliximab-treated patients, higher SDL were associated with the presence of tissue free drug in both inflamed and non-inflamed segments, whereas TNF-drug complexes were mostly detected in non-inflamed but not in inflamed tissue. In the presence of ADA, neither free drug nor TNF-infliximab complexes were measured in the tissue. Tissue levels did not correlate well with clinical, endoscopic, or histological scores. Conclusions: SDL correlated with tissue free drug levels; however, different dynamics were observed for TNF-drug complex levels. Infliximab and adalimumab tissue drug dynamics differ. Better understanding of these interactions may allow future therapeutic optimisation.

Original languageEnglish
Pages (from-to)884-892
Number of pages9
JournalJournal of Crohn's and Colitis
Issue number6
StatePublished - 1 Jun 2022


FundersFunder number
Leona M. and Harry B. Helmsley Charitable Trust
Meso Scale Diagnostics
Takeda Pharmaceutical Company
Janssen Pharmaceuticals


    • Anti-TNF
    • IBD
    • biopsies
    • drug levels


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