A69 INFLIXIMAB DOSE OPTIMIZATION DURING MAINTENANCE THERAPY IN CHILDREN WITH IBD
Bibliographic record
Abstract
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 To evaluate the impact of IFX dose optimization during maintenance therapy in children 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 x2 and a p<0.05 was considered significant 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 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 None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".