Infliximab in young paediatric IBD patients: it is all about the dosing.
Eur J Pediatr
; 179(12): 1935-1944, 2020 Dec.
Article
em En
| MEDLINE
| ID: mdl-32813123
ABSTRACT
Infliximab (IFX) is administered intravenously using weight-based dosing (5 mg/kg) in inflammatory bowel disease (IBD) patients. Our hypothesis is that especially young children need a more intensive treatment regimen than the current weight-based dose administration. We aimed to assess IFX pharmacokinetics (PK), based on existing therapeutic drug monitoring (TDM) data in IBD patients < 10 years. TDM data were collected retrospectively in 14 centres. Children treated with IFX were included if IFX was started as IBD treatment at age < 10 years (young patients, YP) and PK data were available. Older IBD patients aged 10-18 years were used as controls (older patients, OP). Two hundred and fifteen paediatric inflammatory bowel disease (PIBD) patients were eligible for the study (110 < 10 year; 105 ≥ 10 years). Median age was 8.3 years (IQR 6.9-8.9) in YP compared with 14.3 years (IQR 12.8-15.6) in OP at the start of IFX. At the start of maintenance treatment, 72% of YP had trough levels below therapeutic range (< 5.4 µg/mL). After 1 year of scheduled IFX maintenance treatment, YP required a significantly higher dose per 8 weeks compared with OP (YP; 9.0 mg/kg (IQR 5.0-12.9) vs. OP; 5.5 mg/kg (IQR 5.0-9.3); p < 0.001). The chance to develop antibodies to infliximab was relatively lower in OP than YP (0.329 (95% CI - 1.2 to - 1.01); p < 0.001), while the overall duration of response to IFX was not significantly different (after 2 years 53% (n = 29) in YP vs. 58% (n = 45) in OP; p = 0.56).Conclusion:
Intensification of the induction scheme is suggested for PIBD patients aged < 10 years. What is Known? â¢Infliximab trough levels of paediatric IBD patients are influenced by several factors as dosing scheme, antibodies and inflammatory markers. â¢In 4.5-30% of the paediatric IBD patients, infliximab treatment was stopped within the first year. What is New? â¢The majority of young PIBD (< 10 years) have inadequate IFX trough levels at the start of maintenance treatment. â¢Young PIBD patients (< 10 years) were in need of a more intensive treatment regimen compared with older paediatric patients during 1 year of IFX treatment. â¢The chance to develop antibodies to infliximab was relatively higher in young PIBD patients (< 10 years).Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Fármacos Gastrointestinais
/
Doenças Inflamatórias Intestinais
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Infliximab
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article