Toskas Alexandros, Manti Magdalini, Kamperidis Nikolaos, Arebi Naila
Gastroenterology, St Mark's Hospital and Academic Institute, London, GBR.
Cureus. 2024 Dec 26;16(12):e76424. doi: 10.7759/cureus.76424. eCollection 2024 Dec.
The therapeutic failure of infliximab therapy remains a challenge in patients with inflammatory bowel disease (IBD), and dose optimization is often required. Accelerated or intensified regimes showed value in treating patients in the acute setting with high CRP or low albumin levels, which are suggested by recent guidelines; however, evidence is weak. Therapeutic drug monitoring (TDM), with anti-tumor necrosis factor-alpha (TNF-α) trough levels and antibodies, showed value during maintenance therapy, but not in induction and can guide clinical decisions in patients that might be undertreated with the standard dosing regimen. Combining the impact of therapeutic drug monitoring with a Bayesian forecasting methodology to calculate drug clearance can help on calculating the optimal infliximab dose for patients with ulcerative colitis (UC) and Crohn's disease (CD) on both the induction and maintenance phase. This will help to identify those who need intensification of their current regime to boost the therapeutic effect and those who are non-responders. This review aims to summarize the recent literature regarding infliximab precision dosing in IBD patients using forecasting methodology.
英夫利昔单抗治疗失败在炎症性肠病（IBD）患者中仍然是一项挑战，通常需要优化剂量。加速或强化治疗方案在治疗急性发作且C反应蛋白（CRP）高或白蛋白水平低的患者中显示出价值，这是近期指南所建议的；然而，证据并不充分。治疗药物监测（TDM），通过检测抗肿瘤坏死因子-α（TNF-α）谷浓度和抗体，在维持治疗期间显示出价值，但在诱导治疗中并非如此，并且可以指导那些可能未接受标准给药方案充分治疗的患者的临床决策。将治疗药物监测的影响与贝叶斯预测方法相结合以计算药物清除率，有助于为溃疡性结肠炎（UC）和克罗恩病（CD）患者在诱导期和维持期计算最佳英夫利昔单抗剂量。这将有助于识别那些需要强化当前治疗方案以提高治疗效果的患者以及那些无反应者。本综述旨在总结近期关于使用预测方法对IBD患者进行英夫利昔单抗精准给药的文献。
