Año 2023 / Volumen 115 / Número 8
Original
Impact of proactive therapeutic drug monitoring of infliximab during the induction phase in IBD patients. A Bayesian approach

435-443

DOI: 10.17235/reed.2022.8781/2022

Lidia Serrano-Díaz, Carles Iniesta-Navalón, Rosa Gómez-Espín, Isabel Nicolás-de Prado, Enrique Bernal-Morell, Lorena Rentero-Redondo,

Resumen
Background and objectives: there is increasing evidence that proactive therapeutic drug monitoring in induction is useful to improve the control of inflammatory bowel disease (IBD), although it remains controversial. The primary objective of the study was to assess the short-term outcomes of proactive Bayesian therapeutic drug monitoring (TDM) during induction, to optimize infliximab (IFX) maintenance dose. Methods: retrospective observational cohort of IBD patients > 18 years. They were divided into two cohorts, standard therapy group (ST-group), with clinically based dose adjustment, and monitoring group (iTDM-group), with pharmacokinetic parameters calculated by Bayesian prediction at week 6 and individualized dosage regimens thereafter. In patients with an infliximab trough level (ITL) at week 6 below the optimal therapeutic range, the dose adjustment was performed at the first maintenance dose. Results: a total of 153 patients were included, 40 in the iTDM-group. Median ITL at week 6 during the induction period was 12.8 µg/ml (IRQ: 12.7) in this group. Only 16 patients (40.0 %) had ITL ≥ 15 µg/ml. Half of the patients (50.3 %) received intensified maintenance therapy during the study period (57.5 % iTDM vs 47.8 % ST, p = 0.291). The proportion of patients achieving primary response at week 14 was 51.8 %. When comparing the two groups, this proportion was higher in the iTDM group (74.3 % vs 44.2 %, p = 0.002). With regards to the variable “poor clinical outcomes” at week 26, this proportion was lower in the iTDM group (3.3 % iTDM vs 21.1 % ST, p = 0.024). Conclusions: proactive therapeutic drug monitoring using Bayesian approach is associated with higher primary response rates and fewer short-term complications.
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Bibliografía
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Instrucciones para citar
Serrano-Díaz L, Iniesta-Navalón C, Gómez-Espín R, Nicolás-de Prado I, Bernal-Morell E, Rentero-Redondo L, et all. Impact of proactive therapeutic drug monitoring of infliximab during the induction phase in IBD patients. A Bayesian approach. 8781/2022


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Ficha Técnica

Recibido: 11/03/2022

Aceptado: 01/12/2022

Prepublicado: 23/12/2022

Publicado: 26/07/2023

Tiempo de revisión del artículo: 259 días

Tiempo de prepublicación: 287 días

Tiempo de edición del artículo: 502 días


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