Inflectra drug and antibody levels

Blood Sciences Test

Specimen

Serum

Special instructions

Please note- this service is funded by Pfizer plc and is only available for patients receiving the anti TNFalpha Inflectra.

When requesting this test you must request Inflectra, otherwise the requesting location will be charged- please see more details below in referral from external organisations.

Units

mg/L

New Calibration in use from 1st April 2019

For full details please see https://www.exeterlaboratory.com/test/infliximab-drug-levels/

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Test Usage

Managing inflammatory bowel disease patients with anti-TNF biological medicines such as Infliximab is challenging. Patients may respond well to treatment initially, only to encounter loss or response further ahead in their treatment pathway. Others may not respond to treatment at all. One approach to potentially improve outcomes for patients on Infliximab is to measure trough drug levels and to determine if patients have developed antibodies to the drug. However, drug level and antibody testing will only be useful if it actually creates positive outcomes for patients. The challenge lies in optimising when these analyses take place and how best to interpret the data in making clinical decisions that benefit patients.

For further interpretation please see: Anti TNF monitoring guidance

References

Perry M, Bewshea C, Brown R, So K, Ahmad T, McDonald T. Infliximab and adalimumab are stable in whole blood clotted samples for seven days at room temperature. .Ann Clin Biochem.2015 Mar 16. pii: 0004563215580001.

AVAILABILITY

Local test

TURNAROUND TIME

10 working days

Can be added on to an existing request

REFERRALS

Referral From External Organisations

We welcome referrals for Inflectra monitoring from any organisation. If you are a new requestor please complete the following form: New Requestor Form v3.

We now also have the option to use NPEx for referral requesting.

IMPORTANT: Please add which of the scenarios below reflect your current process for Anti TNF drug and antibody monitoring

We have outlined below the process of sending new referral for inflectra drug and antibody levels to Exeter. It is important the processes below are followed to allow testing for free:

Scenario 1 – The Gastroenterology unit currently prescribes Remicade and sends samples to their local laboratory for analysis of drug and antibody levels who refer on to Exeter

Gastroenterology continues sending to local laboratory exactly as previously, but requesting INFLECTRA
Local laboratory sends the referral to Exeter as previously, but request INFLECTRA testing
Exeter laboratory processes for drug and antibody levels and reports Infliximab and antibodies, as currently, but with a reporting comment indicating INFLECTRA patient
Exeter laboratory now invoices Pfizer directly for the analysis

Scenario 2 – The Gastroenterology unit currently uses Remicade and sends samples to their local laboratory for analysis of drug and antibody levels to an alternative provider

Gastroenterology liaises with local laboratory to redirect requests to Exeter
Gastroenterology continues sending to local laboratory exactly as previously, but requesting INFLECTRA
Local laboratory sends the referral to Exeter requesting INFLECTRA testing
Exeter laboratory processes for drug and antibody levels and reports Infliximab and antibodies, but with a reporting comment indicating INFLECTRA patient
Exeter laboratory invoices Pfizer directly for the analysis

Scenario 3 – The Gastroenterology unit does not currently monitor levels

Gastroenterology liaises with local laboratory to refer requests for INFLECTRA to Exeter
Gastroenterology sends samples to local laboratory, requesting INFLECTRA
Local laboratory sends the referral to Exeter requesting INFLECTRA testing
Exeter laboratory processes for drug and antibody levels and reports Infliximab and antibodies, but with a reporting comment indicating INFLECTRA patient
Exeter laboratory invoices Pfizer directly for the analysis

Scenario 4 – The Gastroenterology unit currently uses Remsima and sends samples to their local laboratory for analysis of drug and antibody levels who refer on to Exeter

Gastroenterology continues sending to local laboratory exactly as previously, but requesting INFLECTRA
Local laboratory sends the referral to Exeter as previously, but request INFLECTRA testing
Exeter laboratory processes for drug and antibody levels and reports Infliximab and antibodies, as currently, but with a reporting comment indicating INFLECTRA patient
Exeter laboratory now invoices Pfizer directly for the analysis

Scenario 5 – The Gastroenterology unit currently uses Remsima and sends samples for analysis of drug and antibody levels directly to Exeter

Gastroenterology liaises with local laboratory to refer requests for INFLECTRA to Exeter
Gastroenterology sends samples to local laboratory, requesting INFLECTRA
Local laboratory sends the referral to Exeter requesting INFLECTRA testing
Exeter laboratory processes for drug and antibody levels and reports Infliximab and antibodies, but with a reporting comment indicating INFLECTRA patient
Exeter laboratory invoices Pfizer directly for the analysis

If you have any further enquiries please contact Adrian Cudmore by email: Adrian.Cudmore@nhs.net

^Disclaimer

^{Pfizer Ltd funds the provision of the Inflectra testing services provided by Exeter Clinical Laboratories International. This service is only available to healthcare professionals for use with patients who have been prescribed Inflectra. This service is provided by Pfizer Ltd as part of a patient support programme.}

^{By using this webpage the user agrees that Pfizer Ltd shall have no liability in respect of the completeness or accuracy of the testing services (including in respect of any medical decision taken in reliance upon the results of such testing), for which Exeter Clinical Laboratories International shall have sole responsibility. Save as required by law (including pursuant to adverse event reporting laws), Pfizer Ltd will not receive any sensitive personal data or personal data of the webpage user or of any patient using Inflectra and on whose behalf the testing services are provided.}

^{If you have any queries or require any assistance, please contact Mr Adrian Cudmore, Laboratory Manager, Department of Blood Sciences Tel 01392 402904 adrian.cudmore@nhs.net}

Specimen Labelling Procedure