By contrast, we just took under consideration the interval of to 1 month before or after test collection up

By contrast, we just took under consideration the interval of to 1 month before or after test collection up. on the brief moment of collection. Additionally, the purpose of Teixeira et al. 4 was to Spiramycin gauge the serum degrees of IFX by evaluating two different, validated already, assays 6,7. Although this process was interesting certainly, nearly all sufferers contained in the research (88%) had been in remission, an ailment that’s not impacted by healing medication monitoring in scientific practice. Teixeira et al. 4 also suggested that even more research on sufferers with energetic disease will be required. Finally, Parra et al. 5 examined Rabbit polyclonal to ALP the degrees of IFX in a more substantial cohort of 55 sufferers with Compact disc and 16 with UC. The novelty of the study was the use of a quality of life questionnaire and its correlation with the serum trough levels of IFX. Although they did perform their analysis considering patients in a state of disease activity or remission, the criterion for disease activity was based on an elective colonoscopy examination performed at least three months before and three months after blood collection. This interval can be deemed rather too long in the case of inflammatory bowel diseases. By contrast, we only took into consideration the interval of up to one month before or after sample collection. Moreover, as acknowledged by Parra et al. 5 themselves, they did not include variables for either proinflammatory biomarkers (such as CRP and fecal calprotectin) or body mass index (BMI) in their analysis. We assessed the serum albumin levels of all patients included in our research. All of the studies cited above performed analyses that included patients with CD and ulcerative colitis (UC). Our study included only CD patients because the molecular characteristics of each disease may differ in response to a specific drug. For histological healing, for example, the IFX trough level requirement for CD cases is usually 9.8 g/mL, whereas it is 10.5 mg/L for UC patients 8,9. Our study is the first Brazilian prospective observational study to measure the levels of IFX and ATIs in CD patients, assessing disease activity by colonoscopy or nuclear magnetic resonance (NMR), including in the analysis at least one nutritional parameter (albumin level) that is relevant to the drug pharmacokinetics 10 (reference 27 of the Gomes et al. manuscript). Therefore, it should not at all come as a surprise that patients with a relatively favorable nutritional parameter, such as albumin, present adequate or supratherapeutic levels of IFX in both groups (active and in remission). Recently, we published a paper regarding the nutritional aspects of 60 CD patients receiving treatment at our institution 11. Although relevant differences were observed in nutritional markers for patients in remission and with active disease, the prealbumin serum levels did not differ between these groups. We emphasize the need for a multidisciplinary team, including nutritional follow-up, so that these patients can achieve better outcomes. Regarding the therapeutic window noted by Teixeira et al. 1, Ungar et al. 12 found a significant association between anti-TNF- serum levels and Spiramycin mucosal healing, which led to the recommendation that a serum level of 6-10 g/mL for IFX is necessary to achieve healing of 80%-90% of IBD patients, which may be considered a therapeutic window as well. Moreover, this interval was followed in other studies in the literature 13-15. Some authors propose minimum levels of up to 10 g/mL Spiramycin or even 18 g/mL for fistula healing 12,14. Drobne et al. recently observed that maintaining higher infliximab levels 7 g/mL provided better control of IBD without Spiramycin an increased risk of contamination 13. Our choice for the quantitative ELISA from Promonitors (Progenika Biophama, S. A. Spain) was due to its widespread use in other institutions around the world and its greater availability for purchase in our location, in addition to the possibility to perform the ELISA test in our laboratory and to standardize the technique without the need to send samples abroad, which would involve high costs and additional approvals by national research ethical committees. Concerning the comments of Teixeira et al. 1 about why we might have mixed the results of the study because several patients with levels between 3-6 g/mL would be considered.