A146 ASSESSMENT OF THE USE OF THERAPEUTIC DRUG MONITORING OF INFLIXIMAB DURING MAINTENANCE IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".