Infliximab total anti-drug antibody

Immunology

Tumor Necrosis Factor alpha (TNFɑ) belongs to the proinflammatory cytokines which promote and sustain inflammatory reactions. It is produced by macrophages and T cells and plays a central role in both acute and chronic inflammations. Consequently, chronic inflammatory diseases like Crohn’s disease, ulcerative colitis, rheumatoid arthritis, or psoriasis are increasingly being treated with antibodies against TNFɑ, which target directly the underlying inflammatory process.

During recent years, reports of an association between anti-drug antibodies (ADAs) and adverse effects of treatments both in CD and UC have surfaced. Development of ADAs is usually considered to be associated to immunogenicity of monoclonal antibodies. The clinical efficacy of an anti-TNFɑ therapy usually correlates with the trough level of the therapeutic antibody, or the drug level just before the next application of the anti-TNFɑ antibody. Several factors influence the trough level, among them dosage and frequency of anti-TNFɑ blocker infusion, disease activity, individual pharmacokinetics and immune reaction (formation of anti-drug antibodies, ADA). It is thought that ADA functionally neutralize the therapeutic antibodies or induce their rapid elimination. Consequences of ADA formation can be therapy failure and allergic reactions during anti-TNFɑ antibody application.

The IDKmonitor® Infliximab total ADA ELISA for the detection of total antibodies against infliximab measures free and bound antibodies against infliximab. This assay allows a reliable determination of ADA even in the presence of infliximab; therefore, it is ideal for therapy monitoring when a measurable infliximab concentration is expected, for example shortly after last infusion. In combination with the drug level determination, the IDKmonitor® Infliximab total ADA ELISA is an opportunity for the treating physician to monitor and optimize treatment early on.

Preparation of Patient: No special preparation.

Sample Type:

Serum (Gold and red cap); Plasma (lavender cap)

Temperature: + 4ºC or spun, separated and frozen at -20°C

Turnaround Time:

10 working days

Sample Stability:

Whole blood: unknown.

Separated: RT 7 days. Longer @ -20ºC

Instrument / Procedure:

ELISA

Units:
Reference Range:

(AU/mL) - A total Infliximab Antibody concentration >/= 10 AU/mL is positive.

This assay measures TOTAL infliximab antibody concentration, and is not sensitive to the presence of drug.

Precautions:
Download full Primary Sample Management Document
Source:

IDK total Infliximab Antibody level IFU

Accreditation Status:
Yes
No

SAMPLE REQUIREMENTS FOR COAGULATION TESTS

PROCEDURE

Sample Requirements and Collection

  • Patients should be relaxed pre-venepuncture. Excessive stress and exercise will increase FVIII, vWF antigen and fibrinolysis. Venous occlusion should be avoided.
  • Difficult venepuncture with trauma may lead to platelet activation with release of PF4 fromalpha granules.
  • Venous blood should be collected into coagulation tubes containing Sodium Citrate 3.2%, 0.105M, 3ml.
  • Specimens must be mixed immediately post venepuncture to avoid clot activation, by GENTLY inverting the tubes 5 to 10 times.
  • The ratio of whole blood to anticoagulant is crucial. Under-filled specimens will not be processed as over- or under-filled tubes can adversely affect results.
  • Any warfarin treatment should be mentioned on the request form.

Transportation and Storage

  • PT/INR specimens should ideally be analysed within 12 hours of collection and transported to the laboratory at room temperature.
  • APTT and Fibrinogen should ideally be analysed within 4 hours of collection. Where this is not possible please centrifuge at room temperature (RT) @3000rpm (1500g) for at least 15 minutes, and then carefully remove the plasma from the cells, transfer to a fresh plastic plain tube and freeze at -20oC.
  • Non-frozen coagulation specimens should be transported at RT ASAP to avoid deterioration of labile factors V and VIII.
  • Collection of blood through intravenous lines that have been previously flushed with heparin should be avoided. In the event blood is drawn from an indwelling catheter, the line should be flushed with 5ml of saline, and the first 5ml of blood or 6 times the line volume be drawn off and discarded before coagulation tube is filled.

Plasma Sample Stability (CLSI H21-A5)

  • PT 24 hours @ RT or 2 weeks @ -20oC
  • APTT 4 hours @ RT or 2 weeks @ -20oC & 12 Months @ -70oC
  • Fibrinogen - 4 hours @ RT `

ESR Ref Ranges
Units of Measurement
MALE
FEMALE
>50 Years
mm/hr
0 - ≤12
0 - ≤15
<50 Years
mm/hr
0 - ≤8
0 - ≤10
Analyte
Units of Measurement
MALE
FEMALE
WBC
10^9/L
4.0 - 10.0
4.0 - 10.0
RBC
10^12/L
4.5 - 5.5
3.8 - 4.8
HB
g/dL
13.0 - 17.0
12.0 - 15.0
HCT
L/L
0.400 - 0.500
0.360 - 0.460
MCV
fL
83 - 101
83 - 101
MCH
pg
27 - 32
27 - 32
MCHC
g/dL
31.5 - 34.5
31.5 - 34.5
PLT
10^9/L
150 - 410
150 - 410
MPV
fL
N/A
N/A
RDW
%
11.6 - 14.0
11.6 - 14.0
#Neut
10^9/L
2.0 - 7.0
2.0 - 7.0
#Lymph
10^9/L
1.0 - 3.0
1.0 - 3.0
#Mono
10^9/L
0.2 - 1.0
0.2 - 1.0
#Eos
10^9/L
0.02 - 0.50
0.02 - 0.50
#Baso
10^9/L
0.02 - 0.10
0.02 - 0.10
Analyte
Units of Measurement
MALE
FEMALE
WBC
10^9/L
Up to 1 year (6.00-16.00)
Up to 6 years (5.00-15.00)
Up to 12 years (5.00-13.00)
Up to 18 years (3.88-10.49)
Up to 1 year (6.00-16.00)
Up to 6 years (5.00-15.00)
Up to 12 years (5.00-13.00)
Up to 18 years (3.88-10.49)
RBC
10^12/L
Up to 1 year (3.90-5.10)
Up to 12 years (4.00-5.20)
Up to 18 years (4.28-5.59)
Up to 1 year (3.90-5.10)
Up to 12 years (4.00-5.20)
Up to 18 years (3.73-5.02)
HB
g/dL
Up to 1 year (11.1-14.1)
Up to 6 years (11.0-14.0)
Up to 12 years (11.5-15.5)
Up to 18 years (13.5-17.2)
Up to 1 year (11.1-14.1)
Up to 6 years (11.0-14.0)
Up to 12 years (11.5-15.5)
Up to 18 years (11.3-15.2)
HCT
L/L
Up to 1 year (0.300-0.380)
Up to 6 years (0.340-0.400)
Up to 12 years (0.350-0.450)
Up to 18 years (0.381-0.499)
Up to 1 year (0.300-0.380)
Up to 6 years (0.340-0.400)
Up to 12 years (0.350-0.450)
Up to 18 years (0.323-0.462)
MCV
fL
Up to 1 year (72.0-84.0)
Up to 6 years (75.0-87.0)
Up to 12 years (77.0-95.0)
Up to 18 years (83.1-99.1)
Up to 1 year (72.0-84.0)
Up to 6 years (75.0-87.0)
Up to 12 years (77.0-95.0)
Up to 18 years (83.1-99.1)
MCH
pg
Up to 1 year (25.0-29.0)
Up to 6 years (24.0-30.0)
Up to 12 years (25.0-33.0)
Up to 18 years (28.3-33.9)
Up to 1 year (25.0-29.0)
Up to 6 years (24.0-30.0)
Up to 12 years (25.0-33.0)
Up to 18 years (28.3-33.9)
MCHC
g/dL
Up to 1 year (32.0-36.0)
Up to 6 years (31.0-37.0)
Up to 12 years (31.0-37.0)
Up to 18 years (32.1-36.6)
Up to 1 year (32.0-36.0)
Up to 6 years (31.0-37.0)
Up to 12 years (31.0-37.0)
Up to 18 years (32.1-36.6)
PLT
10^9/L
Up to 1 year (200-550)
Up to 6 years (200-490)
Up to 12 years (170-450)
Up to 18 years (164-382)
Up to 1 year (200-550)
Up to 6 years (200-490)
Up to 12 years (170-450)
Up to 18 years (164-382)
RDW
%
No separate paediatric ranges
No separate paediatric ranges
#Neut
10^9/L
Up to 1 year (1.00-7.000)
Up to 6 years (1.50-8.00)
Up to 12 years (2.00-8.00)
Up to 18 years (1.56-6.52)
Up to 1 year (1.00-7.000)
Up to 6 years (1.50-8.00)
Up to 12 years (2.00-8.00)
Up to 18 years (1.56-6.52)
#Lymph
10^9/L
Up to 1 year (3.50-11.00)
Up to 6 years (6.00-9.00)
Up to 12 years (1.00-5.00)
Up to 18 years (1.01-3.13)
Up to 1 year (3.50-11.00)
Up to 6 years (6.00-9.00)
Up to 12 years (1.00-5.00)
Up to 18 years (1.01-3.13)
#Mono
10^9/L
Up to 1 year (0.20-1.00)
Up to 6 years (0.20-1.00)
Up to 12 years (0.20-1.00)
Up to 18 years (1.01-3.13)
Up to 1 year (0.20-1.00)
Up to 6 years (0.20-1.00)
Up to 12 years (0.20-1.00)
Up to 18 years (1.01-3.13)
#Eos
10^9/L
Up to 12 years (0.10-1.00)
Up to 18 years (0.05-0.51)
Up to 12 years (0.10-1.00)
Up to 18 years (0.05-0.51)
#Baso
10^9/L
Up to 1 day (0.00-0.64)
Up to 7 days (0.00-0.25)
Up to 14 years (0.00-0.23)
Up to 18 years (0.02-0.15)
Up to 1 day (0.00-0.64)
Up to 7 days (0.00-0.25)
Up to 14 years (0.00-0.23)
Up to 18 years (0.02-0.15)
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