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Dashboard-Driven Accelerated Infliximab Induction Dosing Increases Infliximab Durability and Reduces Immunogenicity. | LitMetric

AI Article Synopsis

  • A study was conducted to evaluate how using a dashboard-guided approach for infliximab (IFX) dosing impacts the treatment effectiveness and immune response in patients with inflammatory bowel disease (IBD).
  • The research involved both pediatric and adult patients, collecting data to personalize dosing based on individual characteristics and response, aiming for specific drug levels after their third and fourth infusions.
  • Results showed that a significant number of patients benefited from accelerated dosing, and adherence to the dashboard's recommendations was linked to fewer antidrug antibodies and a higher likelihood of remaining on IFX treatment after one year.

Article Abstract

Background And Aims: Accelerated infliximab (IFX) induction is often based on clinical parameters as opposed to pharmacokinetics (PK). We aimed to investigate the impact of dashboard-guided optimized induction dosing on IFX durability and immunogenicity in a real-world inflammatory bowel disease (IBD) setting.

Methods: Pediatric and adult IBD patients were enrolled in a prospective single arm intervention trial. Cumulative data from each infusion (INF), weight, albumin, C-reactive protein, IFX dose, IFX trough level, and antidrug antibody presence were used to inform subsequent INF dosing. Forecasts driven by adaptive Bayesian modeling were generated to maintain trough levels for the third (INF3) and fourth (INF4) infusions of 17 μg/mL and 10 μg/mL, respectively. The primary outcome was proportion of patients prescribed accelerated dosing (AD) intervals by INF3 (<22 days) or INF4 (<49 days). Secondary outcomes included week 52 clinical and PK outcomes. Multivariate analyses and Kaplan-Meier curves compared outcomes based on adherence to dashboard forecasts.

Results: Of the 180 per-protocol population, AD was forecast for 41% (INF3) and 69% (INF4) of patients with median intervals of 17 (INF3) and 39 (INF4) days. Baseline age >18 years, albumin >3.5 g/L, and 10-mg/kg dose were independently associated with lower rates of AD by INF4. Nonadherence with the INF4 forecast (n = 39) was an independent predictor of antidrug antibody (P < .0001) and IFX discontinuation (P = .0006). A total of 119 of 123 patients on IFX at week 52 were in steroid-free remission.

Conclusions: The application of a PK dashboard during induction can optimize dosing early to improve IFX durability and immunogenicity.

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Source
http://dx.doi.org/10.1093/ibd/izab285DOI Listing

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