Review article: dose optimisation of infliximab for acute severe ulcerative colitis

Hindryckx, Pieter; Novak, Gregor; Casteele, Niels Vande; Laukens, Debby; Parker, Claire E; Shackelton, Lisa M.; Narula, Neeraj; Khanna, Reena; Dulai, Parambir S.; Levesque, Barrett G.; Sandborn, William J.; D’Haens, Geert R.; Feagan, Brian G.; Jairath, Vipul

doi:10.1111/apt.13913

Cited by 80 publications

(67 citation statements)

References 82 publications

(182 reference statements)

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“…This may be attributed to the severity of UC in the pediatric population, resulting in a more systemic effect, as reflected in a much higher proportion of pediatric patients with pancolitis compared with adult patients with UC . Despite the fact that UC is considered a mucosal disease, restricted to the large bowel, the inflammatory burden in patients with pancolitis is extremely high and often requires intensification of anti‐inflammatory treatment . Thus, it should not be surprising that iron and zinc deficiencies remain high in pediatric patients with UC.…”

Section: Discussionmentioning

confidence: 99%

Micronutrient Deficiencies in Children With Inflammatory Bowel Diseases

et al. 2019

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Background Children with inflammatory bowel diseases (IBDs) are at risk of developing nutrition deficiencies, particularly because of reduced intake, restrictive diets, malabsorption, and excessive nutrient loss. In this study, we aimed to assess the status of trace elements, minerals, and vitamins in a large cohort of children with IBDs. Methods Medical records of children diagnosed with IBDs during 2000–2016 were reviewed retrospectively. Retrieved data included demographics, disease characteristics, disease activity indices, anthropometric measures, and specific trace elements, minerals, and vitamins at diagnosis and during follow‐up. Results Out of 359 children with IBD (158 [44%] females, median age at diagnosis 14.1 years, interquartile range [IQR] 12.0–16.0), 240 (67%) were diagnosed with Crohn's disease (CD) and 119 (33%) with ulcerative colitis (UC). Median follow‐up time was 7 years (IQR 5–10). The prevalence of deficiencies in patients with CD at diagnosis and last follow‐up, respectively, were iron (88% and 39.5%), zinc (53% and 11.5%), vitamin D (39% and 36%), and folic acid (10% and 13%). In patients with UC, frequencies were: iron (77% and 40%), vitamin D (49% and 33%), zinc (31% and 10%), and folic acid (3.8% and 9.7%). Magnesium and vitamin B12 deficiencies were rare. For both diseases, iron deficiency was associated with hypoalbuminemia. Deficiencies in iron and zinc were more common in patients with CD than those with UC. Conclusions Deficiencies in iron, zinc, and vitamin D are common at pediatric IBD diagnosis with limited improvement during follow‐up, whereas deficiencies in magnesium and vitamin B12 are rare.

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Section: Discussionmentioning

confidence: 99%

Micronutrient Deficiencies in Children With Inflammatory Bowel Diseases

et al. 2019

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“…Parece racional sugerir, por lo previamente expuesto, que frente a una CUg sea necesario modificar el esquema de inducción ya sea acortando los intervalos de las dosis (0, 1 y 4 semanas) y/o aumentando la dosis del biológico (10 mg/kg) 12 .…”

Section: Discussionunclassified

“…Aunque mayores dosis sean utilizadas, un clearance aumentado del fármaco afectará los niveles hacia el final de cada intervalo 23,24 . En nuestra paciente decidimos utilizar un esquema acelerado (0, 1 y 4 semanas) con aumento de la dosis administrada (10 mg/kg) dado la severidad clínica y endoscópica 12 .…”

Section: Discussionunclassified

“…La CUg se asocia con un mayor nivel circulante de factor de necrosis tumoral (TNF-α) 9 , que se traduce en una mayor actividad inflamatoria, un mayor clearance del fármaco 10 y una pérdida de éste en las deposiciones 11 . Este escenario sugiere que estos pacientes podrían requerir un esquema de inducción con intervalos menores y/o una mayor dosis de infliximab para mantener niveles terapéuticos adecuados 12 . Gibson y cols.…”

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Terapia de inducción acelerada con infliximab en paciente con colitis ulcerosa grave refractaria a corticoides. Caso clínico

et al. 2017

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“…The 90-day colectomy rate was 47% in the dose-intensified group versus 12.5% in the standard induction group (p=0.01). A recent review of all cohort and case–control studies suggests a benefit for IFX dose optimisation in at least 50% of patients with ASUC with an 80% reduction in colectomy rates 74. However, a recent retrospective multicentre study and meta-analysis involving seven studies (181 patients receiving accelerated IFX and 436 receiving standard IFX) found no significant differences in short- or long-term outcomes between the two 75…”

Section: Medical Managementmentioning

confidence: 99%

Optimal management of acute severe ulcerative colitis

Jain

Ahuja

Limdi

2019

Postgraduate Medical Journal

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Acute severe ulcerative colitis is a life-threatening medical emergency, which can be associated with significant morbidity and is preventable through prompt and effective management. Corticosteroids remain the cornerstone of initial therapy, although a third of patients will not respond. Further management hinges on timely decisions with use of rescue therapy with ciclosporin or infliximab, without compromising the health or safety of the patient, or timely surgery. Although such patients need specialist care, it is imperative that emergency care physicians are aware of the important principles of management of this condition to achieve successful outcomes. Risk stratification and the use of predictive models using clinical parameters have reduced the morbidity associated with this condition.We discuss current evidence and present a clinical approach to clinicians involved in the emergency care of patients with acute severe ulcerative colitis in this review.

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Review article: dose optimisation of infliximab for acute severe ulcerative colitis

Abstract: Uncontrolled studies suggest a benefit for infliximab dose optimisation in patients with acute severe UC. A randomised controlled trial in acute severe UC patients comparing a personalised infliximab dose-optimisation strategy with conventional dosing is a research priority.

Cited by 80 publications

References 82 publications

Micronutrient Deficiencies in Children With Inflammatory Bowel Diseases

Micronutrient Deficiencies in Children With Inflammatory Bowel Diseases

Terapia de inducción acelerada con infliximab en paciente con colitis ulcerosa grave refractaria a corticoides. Caso clínico

Optimal management of acute severe ulcerative colitis

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