From the Division of Gastroenterology, Hepatology and Nutrition, BC Children's Hospital and BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada.
the Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, United Kingdom.
J Pediatr Gastroenterol Nutr. 2022 Nov 1;75(5):601-607. doi: 10.1097/MPG.0000000000003587. Epub 2022 Aug 22.
To evaluate the efficacy of standard and optimized infliximab induction dosing in attaining corticosteroid (CS) free clinical remission at week 52 and the effect that post-induction trough levels have on long-term outcome.
Inflammatory bowel disease (IBD) patients ≤18 years commenced on infliximab between August 1, 2016, and August 1, 2018, from Vancouver, Canada, and Glasgow, Scotland, were included. The Glasgow cohort followed standard induction while the Vancouver cohort undertook induction optimization based on clinical, biomarker, and proactive infliximab trough levels. Baseline characteristics and laboratory values were documented.
In total, 140 children were included [median age 14.1 years (interquartile range (IQR) 12.0-16.0)]; 54% male. CS-free clinical remission at week 52 was higher in the optimized group compared to the standard cohort [65/78 (83%) vs. 32/62 (52%), P < 0.001]. Combined CS-free clinical and biomarker remission (CRP < 5 mg/L) was also higher in the optimized compared to the standard cohort [65/78 (83%) vs 25/62 (40%), P < 0.001]. The median post-induction trough level was higher in children who were in CS-free clinical remission at week 52 [3.6 mg/L (1.5-7.1)] vs. those who were not [2.0 mg/L (0.8-4.1), P = 0.04]. The odds of attaining a therapeutic post-induction trough level were almost 4-fold higher in the optimized group than the standard cohort (OR 3.97, 95% CI: 1.89-8.68, P < 0.001).
Standard infliximab induction resulted in less favorable long-term outcomes for pediatric IBD patients. Optimizing induction using clinical, biomarker, and proactive trough levels resulted in higher post-induction trough levels and a greater odds of attaining long-term clinical remission.
评估标准和优化的英夫利昔单抗诱导剂量在第 52 周达到皮质类固醇（CS）无临床缓解的疗效，以及诱导后谷浓度对长期结果的影响。
纳入 2016 年 8 月 1 日至 2018 年 8 月 1 日期间在加拿大温哥华和苏格兰格拉斯哥开始接受英夫利昔单抗治疗的≤18 岁炎症性肠病（IBD）患者。格拉斯哥队列遵循标准诱导，而温哥华队列则根据临床、生物标志物和积极的英夫利昔单抗谷浓度进行诱导优化。记录基线特征和实验室值。
共纳入 140 例儿童[中位年龄 14.1 岁（四分位距（IQR）12.0-16.0）]；54%为男性。与标准组相比，优化组在第 52 周达到 CS 无临床缓解的比例更高[65/78（83%）比 32/62（52%），P<0.001]。与标准组相比，优化组在第 52 周达到 CS 无临床和生物标志物缓解（CRP<5mg/L）的比例也更高[65/78（83%）比 25/62（40%），P<0.001]。在第 52 周达到 CS 无临床缓解的儿童的诱导后谷浓度中位数更高[3.6mg/L（1.5-7.1）]，而未达到 CS 无临床缓解的儿童则更低[2.0mg/L（0.8-4.1），P=0.04]。与标准组相比，优化组达到治疗性诱导后谷浓度的可能性几乎高出 4 倍（优势比 3.97，95%CI：1.89-8.68，P<0.001）。
标准英夫利昔单抗诱导治疗对儿科 IBD 患者的长期结果不利。使用临床、生物标志物和积极的谷浓度优化诱导治疗可提高诱导后的谷浓度，增加达到长期临床缓解的可能性。
