Deora V, et al. – In this assessment, the specialist examined the impact of therapeutic drug monitoring (TDM) on clinical decision–making for children receiving infliximab for inflammatory bowel disease (IBD). They illustrtaed that therapeutic drug monitoring was helpful in guiding the decision–making process for children with IBD on infliximab.

Methods

• In this study, the medical records of children with IBD who had Infliximab trough levels (ITLs) measured between January 2013 and December 2015 at two Canadian tertiary–care centres were explored.
• The indications for TDM, clinical and laboratory disease activity indices, and TDM–driven treatment changes to infliximab therapy were accumulated.

Results

• This study consisted of 107 consecutive serum measurements of ITLs in 73 children (40 boys), with a median age of 16.1 years, including 52 with Crohn's disease.
• TDM was performed due to concerns about clinical disease activity in 24/107 (22.4%) measurements and 83 (77.6%) were ordered as routine tests.
• Of these 38 (35.5%) ITLs were suboptimal (< 3.5 ug/ml) and 36 (34.0%) resulted in more frequent doses of infliximab, with subsequent improvements in disease biomarkers.
• Interval changes were implemented as a result of 34 (32.0%) ITLs, with shorter intervals in 19 (17.0%) cases, and seven (6.5%) ITLs resulted in adding or increasing doses of immunomodulators.
• Moreover, 4 children were switched to adalimumab.