Better pediatric IBD outcomes with higher infliximab trough levels

Last Updated: 2018-10-01

By Reuters Staff

NEW YORK (Reuters Health) - Higher infliximab trough levels are associated with higher remission rates in children with inflammatory bowel disease (IBD), a retrospective study suggests.

Low infliximab trough levels appear to correlate with poor clinical outcomes, but the role of therapeutic drug monitoring (TDM) during infliximab maintenance therapy is poorly studied in pediatric IBD patients.

Dr. Severine Vermeire and colleagues from University Hospitals Leuven in Belgium investigated whether infliximab trough levels during maintenance therapy correlate with clinical, biological, and endoscopic remission in 33 children with Crohn's disease (CD) and 19 children with ulcerative colitis (UC).

As reported September 19th online in the Journal of Crohn's and Colitis, available infliximab trough levels ranged from 1 ug/mL to 48 ug/mL (median during maintenance, 5.0 ug/mL): 29.0% of all infliximab trough levels were supratherapeutic (>7.0 ug/mL), 50.9% were therapeutic (3-7 ug/mL), and 20.1% were subtherapeutic (<3.0 ug/mL).

Median infliximab trough levels during maintenance were significantly higher when children were in clinical remission (5.4 ug/mL versus 4.2 ug/mL when they were not in remission), biological remission (5.2 versus 4.2 ug/mL, respectively), or endoscopic remission (6.5 versus 3.2 ug/mL, respectively).

Based on ROC analysis, the optimal cutoff level for infliximab trough concentration for predicting endoscopic remission was 5.4 ug/mL or higher, which had 66.0% sensitivity, 75.0% specificity, 75.6% positive predictive value, and 65.2% negative predictive value.

"Our data support the value of proactive drug management in children to improve long-term outcome," the researchers conclude. "This now needs to be investigated in prospective studies to show the real benefit of proactive TDM overdose intensification based on symptoms alone."

Dr. Vermeire did not respond to a request for comments.

SOURCE: http://bit.ly/2RgztOF

J Crohns Colitis 2018.