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Inicio Gastroenterología y Hepatología (English Edition) Impact of proactive of infliximab monitoring using the Bayesian approach in the ...
Journal Information
Vol. 46. Issue 7.
Pages 504-511 (August - September 2023)
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Vol. 46. Issue 7.
Pages 504-511 (August - September 2023)
Original article
Impact of proactive of infliximab monitoring using the Bayesian approach in the maintenance phase in patients with inflammatory bowel disease
Impacto de la monitorización proactiva de infliximab en fase de mantenimiento mediante estimación bayesiana en pacientes con enfermedad inflamatoria intestinal
Lidia Serrano Díaz
Corresponding author
lydiaserranodiaz@gmail.com

Corresponding author.
, Carles Iniesta Navalón, Rosa Gómez Espín, Isabel Nicolás de Prado, Lorena Rentero Redondo
Hospital General Universitario Reina Sofía, Murcia, Spain
Article information
Abstract
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Tables (3)
Table 1. Patient characteristics at baseline.
Table 2. Characteristics of infliximab trough concentration among patients in the TDM group.
Table 3. Predictors of clinical outcomes at week 52.
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Abstract
Background and objectives

There is increasing evidence that proactive monitoring is useful in improving the control of inflammatory bowel disease, although it remains controversial. The aim of this study was to evaluate the efficacy of proactive TDM based on the Bayesian approach to optimise the IFX dose compared with the standard of care dosing in patients with IBD.

Methods

Retrospective observational cohort of inflammatory bowel disease patients>18 years. Patients were classified into two groups according to the strategy used to optimise the dose of IFX: a standard therapy group (ST-group) with clinically based dose adjustment and therapeutic drug monitoring group (TDM-group), with estimation of pharmacokinetic parameters calculated by Bayesian prediction.

Results

A total of 153 patients were included. Of these, 75 were in the TDM-group. Clinical response at week 52 was evaluated in 114 patients. The proportion of patients who achieved clinical remission was higher in the TDM than in the ST-group (80.7% vs 61.4%, respectively, p=0.023). A total of 28 patients (24.6%) met the parameters for the composite variable ‘poor clinical outcome’ at week 52. The proportion of patients who reached this outcome was lower in the TDM-group than in the ST-group (12.3% vs 36.8%, respectively, p=0.002).

Conclusions

Proactive therapeutic drug monitoring using Bayesian approach is associated with higher secondary response and fewer long-term complications.

Keywords:
Infliximab
Inflammatory bowel disease
Therapeutic drug monitoring
Maintenance
Proactive
Abbreviations:
ST-group
TDM-group
CD
UC
IBD
TNFα
TDM
IFX
pK
CCRP
FCP
ATI
ELISA
HBI
IQR
RCTs
AGA
ECCO
ESGAR
BRIDGe
PANTS
Resumen
Antecedentes y objetivos

Cada vez hay más evidencia de que la monitorización proactiva es útil para mejorar el control de la enfermedad inflamatoria intestinal (EII), aunque sigue siendo controvertida. El objetivo de este estudio fue evaluar la eficacia de la monitorización de fármacos terapéuticos (TDM) proactiva basada en el enfoque bayesiano en comparación con el manejo estándar en pacientes con EII.

Métodos

Cohorte observacional retrospectiva de pacientes con EEI > 18 años. Los pacientes se clasificaron en dos grupos de acuerdo con la estrategia utilizada para optimizar la dosis de infliximab (IFX): un grupo de terapia estándar (grupo-ST) con ajuste de dosis basado en la clínica y un grupo de monitorización terapéutica del fármaco (grupo-TDM), con estimación de parámetros farmacocinéticos calculados mediante estimación bayesiana.

Resultados

Se incluyeron un total de 153 pacientes. De estos, 75 estaban en el grupo-TDM. La respuesta clínica en la semana 52 se evaluó en 114 pacientes. La proporción de pacientes que alcanzaron la remisión clínica fue mayor en el grupo-TDM que en el grupo-ST (80,7 vs. 61,4%, respectivamente, p = 0,023). Un total de 28 pacientes (24,6%) cumplieron los parámetros de la variable compuesta «resultado clínico deficiente» en la semana 52. La proporción de pacientes que alcanzaron este resultado fue menor en el grupo-TDM que en el grupo-ST (12,3 vs. 36,8%, respectivamente, p = 0,002).

Conclusiones

La TDM proactiva mediante el enfoque bayesiano se asocia con una mayor respuesta secundaria y menos complicaciones a largo plazo.

Palabras clave:
Infliximab
Enfermedad inflamatoria intestinal
Monitorización farmacocinética
Mantenimiento
Proactivo

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