Utility of proactive infliximab levels in paediatric Crohn’s disease
| Autor: | Fariha Balouch, Peter Lewindon, Lana C Steward-Harrison, C Burgess, Claire Reilly |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Combination therapy medicine.medical_treatment Anti-Inflammatory Agents Gastroenterology Inflammatory bowel disease Antibodies 03 medical and health sciences 0302 clinical medicine Crohn Disease Gastrointestinal Agents Recurrence 030225 pediatrics Internal medicine Adalimumab medicine Humans Dosing Child Retrospective Studies Crohn's disease medicine.diagnostic_test business.industry Immunosuppression medicine.disease Infliximab Treatment Outcome Therapeutic drug monitoring Pediatrics Perinatology and Child Health Female business medicine.drug |
| Zdroj: | Archives of Disease in Childhood. 104:251-255 |
| ISSN: | 1468-2044 0003-9888 |
| DOI: | 10.1136/archdischild-2018-315100 |
| Popis: | ObjectiveInfliximab (IFX) has an established role in Crohn’s disease (CD), with serum trough levels of IFX (TLI) increasingly used to optimise dosing. We report the utility of routine, proactive TLI in children on combination therapy with immunosuppression (IS) from a single paediatric centre.MethodsThis is a retrospective chart review of all children with CD receiving IFX therapy conducted betweenJanuary 2014–May 2017. Clinical phenotype, duration of therapy, TLI (µg/mL), drug antibodies, type of IS, biomarkers and changes in management were recorded.Results60 children (8–17 years; median 14.1 years) had 206 TLIs recorded. 56/60 (93%) were on IS, with 5/60 (8%) developing antidrug antibodies (ADAs). 63/206 TLIs were recorded duringan episode of relapse (median 3.0 µg/mL) vs 143/206 TLIs recorded in remission (median 5.2 µg/mL). For children with TLI 7 µg/mL, 7/63 (11%) were in relapse vs 46/143 (32%) in remission. Change in management resulted from 43/206 (21%) TLIs in 31/60 (52%) children: 21 dose escalations, 12 de-escalations and 10 changed to adalimumab. Of 31 postinduction TLIs, 15/17 (88%) children with TLI >7 µg/mL achieved clinical and biochemical remission for the duration of therapy (median 14 months), while 4/5 (80%) children with TLI ConclusionsRoutine, proactive TLIs guide optimal management in children with CD. Postinduction and during maintenance, levels 7 µg/mL with sustained remission. Combination IS with TP and MTX appears to offer comparable TLI and ADA rates. |
| Databáze: | OpenAIRE |
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