PTH-090 Laboratory experience of anti-tnf drug monitoring in routine practice – perspective from the first uk centre
Notice bibliographique
Résumé
Introduction Therapeutic drug monitoring (TDM) of Infliximab (IFX) and Adalimumab (ADAL) has been in use in our centre since 2012. Here we present the TDM experience of our laboratory service at Viapath, St Thomas’ Hospital. Method Anti-TNF requests received between June 2012 and January 2015 were reviewed. All assays were performed using LISA-TRACKER Duo kits automated on eRobot (Theradiag, France). These assays measure free drug and anti-drug antibody (ADAb) and therefore inhibition studies were performed on samples with detectable drug levels (>1 ug/ml) and positive ADAb. Results were classified according to drug levels (DL) and ADAb status. Results The laboratory analysed 2424 (17% internal) samples for IFX (Median DL 3.8 ug/mL, IQR 1.2–6.3) and 1335 (21% internal) samples for ADAL (Median DL 5.2 ug/mL, IQR 3.4–7.3) from IBD patients. Prevalence of detectable antibodies was higher in IFX (10%) than ADAL (4.1%) samples. External requests originated from >90 different hospitals. Number of requests received for both assays doubled from 2013 to 2014 with batch frequency consequently decreasing from fortnightly to weekly. 40 patients had IFX >1 ug/ml and were antibody positive. 16 of these patients were confirmed to have switched to ADAL due to loss of response to IFX therapy. Detectable DL observed in these cases was due to cross reactivity of ADAL with the IFX assay. 11 patients had false positive drug levels and 4 patients had borderline antibodies due to non specific binding. 1 patient had sample collected around infusion. 4 patients had subtherapeutic ADAL (1.1–1.4 ug/ml) and were antibody positive. 1 of these patients was confirmed to have switched to IFX due to loss of response to ADAL therapy. Detectable DL observed in this case was due to cross reactivity of IFX with the ADAL assay. 3 patients had false positive results for ADAL. From the data, it was evident that some centres monitored patients with serial measurements and made subsequent changes to therapy. 63 patients (IFX) and 52 patients (ADAL) had an average of 7 and 3 repeat measurements taken respectively. Conclusion Anti-TNF testing has been embedded in several IBD centres as a way of optimising therapy however variation in TDM practices was observed highlighting the need for national guidance. Significant increase in test requesting suggests assay based treatment strategies combined with clinical assessment is now an accepted practice in IBD. Disclosure of interest Z. Arkir: None Declared, N. Unsworth: None Declared, G. Richards: None Declared, Z. Odho: None Declared, P. Irving Speaker Bureau of: MSD, Abbvie and Takeda.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».