Choi So Yoon, Kang Ben, Lee Jee Hyun, Choe Yon Ho
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pediatrics, Korea University Ansan Hospital, Korea University School of Medicine, Ansan, Korea.
Gut Liver. 2017 Jan 15;11(1):55-61. doi: 10.5009/gnl16041.
BACKGROUND/AIMS: The clinical use of measuring infliximab (IFX) trough levels (TLs) and antibodies against IFX (ATIs) in patients with pediatric inflammatory bowel disease (IBD) remains unclear. We propose measuring these variables to create individual IFX treatment strategies for patients with pediatric IBD.
This retrospective study was conducted in pediatric patients with IBD who received IFX from July 2009 to June 2014.
Samples were available from 39 patients with pediatric IBD. A significant difference was observed in IFX TLs in 16 patients who were in clinical remission (group A) after IFX therapy (median, 3.99 μg/ mL; interquartile range [IQR], 0.30 to 21.96) compared to 23 patients who had a poor response to treatment (group B) (median, 0.88 μg/mL; IQR, 0.00 to 6.80, p=0.002). In group B, 21 patients underwent empiric intensification of IFX treatment. After dose intensification, 17 patients had an improved response to treatment. Four patients still had no response to dose intensification. Therefore, these patients were switched to other biologics.
Patients who had poor responses and subtherapeutic IFX TLs had an improved response to dose intensification. Patients who had ATIs were likely to continue to have no response after dose intensification. Therefore, tailoring individual IFX treatments based on IFX TLs, ATIs, and the clinical response should be considered.
背景/目的：在儿童炎症性肠病（IBD）患者中测量英夫利昔单抗（IFX）谷浓度（TLs）和抗IFX抗体（ATIs）的临床应用仍不明确。我们建议测量这些变量，为儿童IBD患者制定个性化的IFX治疗策略。
本回顾性研究纳入了2009年7月至2014年6月期间接受IFX治疗的儿童IBD患者。
共获得39例儿童IBD患者的样本。IFX治疗后临床缓解的16例患者（A组）的IFX TLs有显著差异（中位数为3.99μg/mL；四分位数间距[IQR]为0.30至21.96），而23例治疗反应不佳的患者（B组）的IFX TLs中位数为0.88μg/mL；IQR为0.00至6.80，p = 0.002）。在B组中，21例患者接受了IFX治疗的经验性强化。剂量强化后，17例患者的治疗反应有所改善。4例患者对剂量强化仍无反应。因此，这些患者改用了其他生物制剂。
反应不佳且IFX TLs低于治疗水平的患者对剂量强化的反应有所改善。有ATIs的患者在剂量强化后可能仍无反应。因此，应考虑根据IFX TLs、ATIs和临床反应来定制个性化的IFX治疗方案。
