Therapeutic Drug Monitoring and Outcome of Infliximab Therapy in Pediatric Onset Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) with pediatric onset has become more prevalent during past decades. Thus, the number of patients with moderate to severe disease subtype treated with antagonists to tumor necrosis factor alpha (TNFα) has concurrently risen. Most pediatric patients initially respond to these drugs but will need dose escalation during the first year of therapy. As pediatric data regarding therapeutic drug monitoring during therapy with TNFα-blocker adalimumab are sparse, this review focuses on the literature on therapeutic drug monitoring of infliximab and how it may guide management.

Therapeutic drug monitoring of biologics in inflammatory bowel disease: unmet needs and future perspectives

“…Multiple prospective studies on the exposure-outcome relationship in both adult and paediatric IBD and post-hoc analyses of RCTs have shown a positive correlation between drug concentrations and favourable therapeutic outcomes (table 1). 102,103 Studies observed similar results during induction and maintenance therapy. In the large prospective PANTS study, 28 infliximab trough concentrations of at least 7•0 μg/mL and adalimumab concentrations (at or close to trough concentration) of at least 12•0 μg/mL at week 14 were associated with clinical remission at both week 14 and week 54.…”

Acute Neurological Involvement after Donor Lymphocyte Infusion for Post-Transplant Viral Infection: The Same Pattern of Novel Cancer Immunotherapy-Related CNS Toxicity?

“…Given its crucial role in the inflammatory process, this molecule has been the therapeutic target of specific pharmacological treatments, the most significant example of which is infliximab, the use of which is approved for pathologies such as rheumatoid arthritis and chronic inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) [ 29 , 30 , 31 ].…”

Therapy outcome related to adalimumab trough levels in pediatric patients with inflammatory bowel disease

“…Decisions on management were made at the discretion of the treating physician and were based on the routine use of the clinical symptom index [17], fecal calprotectin [18][19][20], blood inflammatory marker and drug level measurements, and the presence of drug antibodies when appropriate [7,16]. Clinical disease activity was retrospective scored according to Physician Global Assessment (PGA) on a scale of 1-3 [21].…”

“…Most patients with PIBD initially respond to anti-TNFa therapy but will need dose escalation during the first year of therapy [12][13][14][15]. To guide therapeutic decisions, the use of trough level measurements of infliximab has been established [9,16]. In PIBD, however, published reports on adalimumab levels are scarce.…”