Pharmacist-Driven Therapeutic Infliximab Monitoring at the Point of Care Using Rapidly Assessed Drug Levels in Patients with Inflammatory Bowel Disease.

Autor:	Rentsch CA; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne.; Department of Pharmacy, Alfred Health; and., Ward MG; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Luber RP; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Taylor KM; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Gibson DJ; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Headon B; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Rosella O; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Su HY; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Friedman AB; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Dooley M; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia., Sparrow MP; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne., Gibson PR; Department of Gastroenterology Alfred Health and Central Clinical School, Monash University. Ms. Rentsch is now with the Department of Gastroenterology, Royal Melbourne Hospital, Melbourne.
Jazyk:	angličtina
Zdroj:	Therapeutic drug monitoring [Ther Drug Monit] 2023 Jun 01; Vol. 45 (3), pp. 383-391. Date of Electronic Publication: 2023 Feb 23.
DOI:	10.1097/FTD.0000000000001044
Abstrakt:	Background: Therapeutic monitoring of infliximab is limited by the time lag between drug-level measurement and dose adjustment, along with the cost of dose escalation. Strategies for dose reduction in stable patients on maintenance infliximab at supratherapeutic levels are uncertain. This study determined the feasibility of a pharmacist-driven strategy for immediate dose adjustment using a sliding scale at the point of care in stable patients with inflammatory bowel disease on maintenance therapy. Methods: Adult patients with stable disease undergoing maintenance therapy with infliximab infusions, 5 mg/kg every 8 weeks, were prospectively studied. Trough drug levels were assessed by a rapid assay (and later by ELISA) at all infusions for up to 12 months with immediate but quantitatively small dose adjustment according to a sliding scale targeting a therapeutic range of 3-7 mcg/mL. Disease activity was assessed both clinically and biochemically. Results: The rapid assay and ELISA detected similar infliximab levels, and the strategy added approximately 30 minutes to the duration of infusion events. Only 20% of 48 patients (77% with Crohn disease) had baseline trough infliximab concentrations within the therapeutic range. This value increased 3-fold after 24 and 48 weeks of interventions. One in 2 patients had baseline supratherapeutic levels, and most were brought into the therapeutic range without a discernible impact on disease activity by 1 dose adjustment, but 2 or 3 adjustments were generally needed for 29% of patients with subtherapeutic levels. Overall, drug costs were reduced by 4%. Conclusions: Immediate dose adjustment after infliximab rapid assay performed by a pharmacist using a sliding scale is a feasible strategy. Supratherapeutic infliximab levels can be safely and quickly brought into the therapeutic range using small dose adjustments without affecting disease activity, offsetting (at least partly) costs associated with dose escalation. Competing Interests: C. A. Rentsch has received speaking honoraria from Takeda. M. G. Ward has received speaking honoraria from Janssen, AbbVie, Ferring, Takeda, MSD, and Shire; has received educational grants or research support from MSD, Ferring, and AbbVie; and owns shares in Atmo Biosciences. R. P. Luber has received educational grants from Ferring, Pfizer, and Vifor Pharma. H. J. Su has received speaking honoraria from Janssen. A. B. Friedman received speaking honoraria from Janssen, AbbVie, Ferring, Takeda, and Shire. He has received educational grants and research support from AbbVie, Ferring, Pfizer, Takeda, Orphan, and Janssen. M. P. Sparrow has received educational grants or research support from Ferring, Orphan, and Gilead; speaker fees from Janssen, Abbvie, Ferring, Takeda, Pfizer, and Shire; and has served on advisory boards for Janssen, Takeda, Pfizer, Celgene, Abbvie, MSD, and Emerge Health. P. R. Gibson has served as a consultant or advisory board member for Anatara, Atmo Biosciences, Immunic Therapeutics, Novozymes, Falk Pharma, and Takeda; has received research grants for investigator-driven studies; and owns shares in Atmo Biosciences. The remaining authors declare no conflict of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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