Long-Term Effectiveness and Safety of Proactive Therapeutic Drug Monitoring of Infliximab in Paediatric Inflammatory Bowel Disease : A Real-World Study
Clemente, Susana (Hospital Universitari Vall d'Hebron)
Segarra Cantón, Óscar (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública)
Padullés-Zamora, Núria (Hospital Universitari de Bellvitge)
García García, Sonia (Hospital Universitari Vall d'Hebron)
Álvarez Beltrán, Marina (Hospital Universitari Vall d'Hebron)
Larrosa García, María (Hospital Universitari Vall d'Hebron)
Cabañas Poy, Maria Josep (Hospital Universitari Vall d'Hebron)
Sanz-Martínez, María Teresa (Hospital Universitari Vall d'Hebron)
Vázquez Fariñas, Ana (Universitat Autònoma de Barcelona)
Gorgas Torner, Maria Queralt (Hospital Universitari Vall d'Hebron)
Miarons, Marta (Hospital Universitari Vall d'Hebron)

Date:	2024
Abstract:	Background: This study evaluated the long-term effectiveness and safety of a multidisciplinary early proactive therapeutic drug monitoring (TDM) program combined with Bayesian forecasting for infliximab (IFX) dose adjustment in a real-world dataset of paediatric patients with inflammatory bowel disease (IBD). Methods: A descriptive, ambispective, single-centre study of paediatric patients with IBD who underwent IFX serum concentration measurements between September 2015 and September 2023. The patients received reactive TDM before September 2019 (n = 17) and proactive TDM thereafter (n = 21). We analysed for clinical, biological, and endoscopic remission; treatment failure; hospitalisations; emergency visits; and adverse drug reactions. The IFX doses were adjusted to maintain trough concentrations ≥ 5 µg/mL, with specific targets for proactive TDM. Results: Of the 38 patients, 21 had Crohn's disease (CD), 16 ulcerative colitis (UC), and 1 undetermined IBD. The mean (standard deviation) IFX trough concentrations were 6. 83 (5. 66) µg/mL (reactive) and 12. 38 (9. 24) µg/mL (proactive) (p = 0. 08). No statistically significant differences between groups were found in remission rates or treatment failure. The proactive group had fewer hospitalisations (14. 29% vs. 23. 53%; p = 0. 47) and shorter median hospitalisation days (6 vs. 19; p = 0. 50), although the difference was not statistically significant. The number of patients with adverse reactions (infusion related reactions and infections) was higher in the proactive group (38. 10% vs. 23. 53%; p = 0. 34) but the difference was not significantly different. Conclusions: Proactive TDM showed no significant differences in treatment outcomes compared to reactive TDM. However, the results in both the reactive and proactive TDM groups were not worse than those reported in other studies. Further studies with larger samples are needed to optimize the treatment strategies for pediatric IBD patients.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Therapeutic drug monitoring ; Infliximab ; Inflammatory bowel diseases ; Children
Published in:	Pharmaceutics, Vol. 16 (december 2024) , ISSN 1999-4923

DOI: 10.3390/pharmaceutics16121577
PMID: 39771556

24 p, 1.6 MB

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