1. Bayes‐based dosing of infliximab in inflammatory bowel diseases: Short‐term efficacy
- Author
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Lorena Rodríguez-Alonso, Francisco Rodríguez-Moranta, Jordi Bas Minguet, Eugènia Santacana Juncosa, Jordi Guardiola, Francisco Morandeira Rego, Helena Colom Codina, Núria Padullés Zamora, Ariadna Padullés Zamora, and Katja Serra Nilsson
- Subjects
Adult ,medicine.medical_specialty ,030226 pharmacology & pharmacy ,Inflammatory bowel disease ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Gastrointestinal Agents ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Prospective Studies ,030212 general & internal medicine ,Dosing ,Prospective cohort study ,Pharmacology ,medicine.diagnostic_test ,business.industry ,Bayes Theorem ,Inflammatory Bowel Diseases ,medicine.disease ,Infliximab ,Regimen ,Therapeutic drug monitoring ,Cohort ,Drug Monitoring ,business ,medicine.drug - Abstract
Therapeutic drug monitoring of infliximab can guide clinical decisions in patients with loss of response and in those who can benefit from a de-intensification. The aim of this study was to determine the impact of therapeutic drug monitoring combined with Bayesian forecasting methodology on clinical response in a real-world dataset of patients suffering from inflammatory bowel disease.We performed a single-centre prospective study with one-group pre-test/post-test design in 108 adult inflammatory bowel disease patients treated with model-based dosing of infliximab maintenance treatment. We recorded clinical activity scores (Harvey-Bradshaw index and partial Mayo) and inflammatory biomarkers per patient.The initial infliximab regimen was maintained in 49 (45.4%) patients and was adjusted in 59 (54.6%) patients (34 treatment intensifications, 9 de-intensifications and 16 treatment discontinuations or therapy replacements). The median time from intervention to index measurement was 126 (103-160) days. The overall proportion of patients in clinical remission increased from 65.7% to 80.4% (P.0001) and the median infliximab trough concentrations increased from 3.21 (0.99-5.45) to 5.13 mg/L (3.57-6.53) (P.0001). In the intensified group, the remission rate increased from 35.3% to 61.8% (P = .001) and the percentage of patients in clinical remission or with mild symptoms increased from 76.5% to 94.1%. In the de-intensification cohort, no patients experienced an increase in the Harvey-Bradshaw index or partial Mayo scores, and all patients maintained an infliximab trough concentration of5 mg/L.In our cohort of inflammatory bowel disease patients, Bayes-based optimized dosing improved the short-term efficacy of infliximab treatment.
- Published
- 2020