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Infliximab Level and Anti-drug Antibody for IBD
Test Code36311
CPT Codes
83520, 80230
Preferred Specimen
2 mL serum collected in a red-top tube (no gel)
Patient Preparation
For up to 48 hours before blood draw, do not take multivitamins or dietary supplements containing biotin or vitamin B7.
The blood should be drawn just before the next infusion of infliximab to measure the trough drug level.
Minimum Volume
1 mL
Instructions
The blood should be drawn just before the next infusion of infliximab to measure the trough drug level
Transport Temperature
Refrigerated (cold packs)
Specimen Stability
Room temperature: 48 hours
Refrigerated: 7 days
Frozen -20° C: 28 days
Frozen -70° C: 70 days
Refrigerated: 7 days
Frozen -20° C: 28 days
Frozen -70° C: 70 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis • Serum Separator Tube (SST®) • Grossly icteric
Methodology
Enzyme Linked Immunosorbent Assay (ELISA)
FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
Setup Schedule
Set up: Mon, Tues, Thurs-Sat; Report available: 1-2 days
Clinical Significance
When treatment of inflammatory bowel disease with infliximab or its biosimilar fails, a physician may need to consider treatment options, such as adjusting dose or dosing intervals, switching to a different TNF blocker, or switching to a non-TNF blocker. This test (1) measures infliximab and infliximab-dyyb (inflectra) levels to help differentiate pharmacodynamic or pharmacokinetic conditions to guide therapy, and (2) tests for anti-drug antibodies to help determine if changing the treatment plan is appropriate. The American Gastroenterological Association (AGA) recommends optimal infliximab trough concentration of 5 mcg/mL or greater in patients with active IBD. Data from separate clinical studies suggest an optimal infliximab trough concentration of greater than 3.8 or 6-10 mcg/mL.
Based on the results of clinical equivalence studies, the FDA and the AGA advocate applying infliximab clinical guidance to the use of its biosimilars.
Based on the results of clinical equivalence studies, the FDA and the AGA advocate applying infliximab clinical guidance to the use of its biosimilars.