3
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      A69 INFLIXIMAB DOSE OPTIMIZATION DURING MAINTENANCE THERAPY IN CHILDREN WITH IBD

      abstract

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Inflammatory bowel disease (IBD) activity has historically been monitored based on symptoms and disease activity indices. Recently a “treat to target” strategy was reported to be associated with better outcomes. Optimizing biologic therapy based on Therapeutic Drug Monitoring (TDM) is becoming standard of care for management of IBD patients. However, there are limited data on serum infliximab (IFX) trough levels in Pediatric IBD patients on maintenance therapy

          Aims

          To evaluate the impact of IFX dose optimization during maintenance therapy in children

          Methods

          A chart review of patients on IFX at BC Children’s Hospital was performed. Demographics, CRP, ESR, albumin, PUCAI/PCDAI were recorded along with low IFX trough levels (baseline), and new trough levels following dose adjustments. A request for trough level was determined by the treating physician based clinically and by standard biomarkers of inflammation. Comparison was made between laboratory findings pre and post dose adjustment. A low IFX trough level was defined as serum level <5mg/mL. A patient was considered on maintenance therapy beyond week 14 or after dose #4. The data were analyzed using a t-test and x 2 and a p<0.05 was considered significant

          Results

          One hundred and fifty-one active patients who received their first IFX infusion between Nov/08 and Jan/18 were reviewed. Forty-five patients (22.5%; 34 Crohn Disease (CD) and 11 Ulcerative Colitis (UC)) with low trough levels (<5mg/mL) on maintenance were identified. Median age at diagnosis was 10 years (IQR 8–12); Paris classification CD: A1b (73.5%) L3 (50%) L2 (41.2%) L1 (2.9%) L4a (17.6%) L4b (11.8%) p(41.2%) and B1 (97%), UC: E4 (63.6%) E3 (18.2%) and E2 (18.2%). Concomitant therapy in 82% of patients (Methotrexate 48.6%, Azathioprine 51.4%). The median number of IFX doses at baseline was 15 (IQR 10–30), median dose (mg/kg) 7.8 (IQR 5–10) with dosing interval of 7 weeks (SD 1.23). Baseline trough level was 1.9 (SD 0.97). Request for IFX trough level was based on clinical (31.1%), biochemical (31.1%) and both clinical and biochemical findings (37.8%). Ninety eight percent of patients had dose adjustments (increase dose, decreased interval, or both) with a 6.2-fold increase in trough levels (see table) This was associated with an 18.2% incremental increase in remission rate and further 11% reduction in disease activity

          Conclusions

          Optimizing IFX therapy through TDM during maintenance is beneficial for children with IBD. A higher rate of remission was achieved following dose adjustments in patients with low trough levels

          Parameter Baseline After dose adjustment p value
          Remission n (%) 28 (62.2%) 37 (82.2%) <0.01
          IFX trough level mean (SD) 1.9 (0.97) 7.92 (4.59) <0.01
          Median ESR (IQR) 14 (9–29) 9.5 (5–16.5) <0.01
          Normal CRP n (%) 34 (75.6%) 42 (91.1%) <0.01
          Normal Albumin n (%) 41(91.1%) 44 (97.8%) <0.01
          Funding Agencies

          None

          Related collections

          Author and article information

          Journal
          J Can Assoc Gastroenterol
          J Can Assoc Gastroenterol
          jcag
          Journal of the Canadian Association of Gastroenterology
          Oxford University Press (US )
          2515-2084
          2515-2092
          March 2019
          15 March 2019
          : 2
          : Suppl 2 , Abstracts Accepted to 2019 CDDW™
          : 138-139
          Affiliations
          BC Children’s Hospital, Vancouver, BC, Canada
          Article
          PMC6512735 PMC6512735 6512735 gwz006.068
          10.1093/jcag/gwz006.068
          6512735
          49fadece-afb2-45b8-9007-d56d683c3c71
          © The Author(s) 2019. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

          This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

          History
          Page count
          Pages: 2
          Categories
          Posters Of Distinction
          Poster Session 1
          Immunobiology and Inflammatory Bowel Disease

          Comments

          Comment on this article