A146 ASSESSMENT OF THE USE OF THERAPEUTIC DRUG MONITORING OF INFLIXIMAB DURING MAINTENANCE IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Notice bibliographique
Résumé
Infliximab (IFX) was proven effective in the induction and maintenance of remission in inflammatory bowel diseases (IBD) in both children and adults. There is a significant number of individual who lose response to the medication. Measurable IFX drug levels correlate with clinical response and mucosal healing. Few studies demonstrate that proactive monitoring in children improves drug levels and correlates with clinical response. To assess the blood level of IFX in children during the maintenance period while on a proactive therapeutic drug monitoring management. The primary goal was to correlate improvement in infliximab levels with a proactive dose adjustment approach. The secondary objectives were to correlate the levels with clinical response and to assess the effect of combination therapy. This was a retrospective cohort study. Patients were included if they had at least one serum level of IFX drawn between June 2014 and July 2016, and had a follow-up of at least 3 months following the level. We collected all trough levels drawn during maintenance phase. Levels were analyzed using the progenika promotor-IFX ELISA kit. We collected biochemical markers drawn a maximum of two weeks prior to the IFX level. We also collected clinical assessments at the time of IFX infusion as reported by the patient. This outcome was graded on a three-point scale (well, moderately well and unwell). The physician global assessment (PGA) was also recorded if it was done within 4 weeks of the IFX level. During the study period a total of 301 Children were receiving IFX. Among them, 155 children had at least one IFX serum level. After exclusion of patients with indeterminate colitis, induction levels and non trough levels, there were 146 patients (79.4% CD; 59.6 % boys; 357 IFX levels) evaluated, with a median of 2 levels (1–13) per patient. Thirty six percent were on combination therapy with the majority on methotrexate (65.3%). Patients with CD had a mean IFX level of 3.85 mcg/mL while those with UC had a mean of 5.43 mcg/mL. Levels were subtherapeutic in 40.9% and supratherapeutic in 26.3%. Clinical status as reported by patients and PGA did not correlate with IFX levels. In the patients on combination therapy, we found a statistical significant improvement in infliximab levels post initiation of treatment (p<0.0001). Twenty two percent of patient discontinued infliximab over the study period. Despite dose adjustments, 40% of serum IFX levels were sub-therapeutic. We did not find a correlation between levels and clinical status. Combination therapy did improve levels. TDM may contribute in maintaining longevity of this therapy as compared to reports in the litterature. We feel that TDM is therefore a useful tool in the management of pediatric IBD. None
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
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 tête enseignante, 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 ».