Therapeutic drug monitoring was helpful in guiding the decision‐making process for children receiving infliximab for inflammatory bowel disease

Abstract

Aim This study examined the impact of therapeutic drug monitoring (TDM) on clinical decision‐making for children receiving infliximab for inflammatory bowel disease (IBD). Methods The medical records of children with IBD who had infliximab trough levels (ITLs) measured between January 2013 and December 2015 at two Canadian tertiary‐care centres were examined. The indications for TDM, clinical and laboratory disease activity indices and TDM‐driven treatment changes to infliximab therapy were documented. Results We included 107 consecutive serum measurements of ITLs in 73 children (40 boys), with a median age of 16.1 years, including 52 with Crohn's disease. TDM was performed due to concerns about clinical disease activity in 24/107 (22.4%) measurements and 83 (77.6%) were ordered as routine tests. Of these, 38 (35.5%) ITLs were suboptimal (<3.5 μg/mL) and 36 (34.0%) resulted in more frequent doses of infliximab, with subsequent improvements in disease biomarkers. Interval changes were implemented as a result of 34 (32.0%) ITLs, with shorter intervals in 19 (17.0%) cases, and seven (6.5%) ITLs resulted in adding or increasing doses of immunomodulators. In addition, four children were switched to adalimumab. Conclusion Therapeutic drug monitoring was helpful in guiding the decision‐making process for children with IBD on infliximab.

Impact of therapeutic drug level monitoring on outcomes of patients with Crohn’s disease treated with Infliximab: real world data from a retrospective single centre cohort study

“…The published literature on the impact of TDM on decision making is limited. In a paediatric population,24 TDM resulted in change in management in 34% of cases. Another study of 71 patients reported a change in management for 37% of cases after TDM for SLR 9…”

Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children

“…17 Consequently, the use of therapeutic drug monitoring in IBD patients on IFX has been gaining interest, with more utilization in clinical practice with emerging evidence suggesting better disease outcomes with a treat-to-target approach. 14,22,23 A systematic review that included 14 studies and examined the utility of TDM in children with IBD on anti-TNF agents concluded that TDM had a potential benefit and that incorporating measurements of infliximab trough levels at week 8 or week 14 predicted therapeutic responses and allowed for dose adjustments to reach therapeutic drug concentrations. However, a clinically relevant cutoff level of some anti-TNF agents has not been well defined yet, and the optimal intervention strategy still has to be determined.…”

Biomarkers for Optimization and Personalization of Anti-TNFs in Pediatric Inflammatory Bowel Disease

“…For this reason, therapeutic drug monitoring (TDM) has been proposed as a means of optimizing biological therapies in both adults [70][71][72][73] and children [52,[74][75][76] with IBD. This approach appears to be more advantageous in pediatric patients, since fluctuations in pharmacokinetic variables tend to be more pronounced in children than in adults, possibly owing to physiological differences, such as volume of distribution, and immaturity of enzyme systems and of clearance mechanisms [52].…”