Therapeutic Drug Monitoring. Publish Ahead of Print():, JULY 03, 2019
DOI: 10.1097/FTD.0000000000000669
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PMID: 31283556
Issn Print: 0163-4356
Publication Date: July 03, 2019
PREDICTORS OF INFLIXIMAB TROUGH CONCENTRATIONS IN INFLAMMATORY BOWEL DISEASE PATIENTS USING A REPEATED MEASURES DESIGN
Eugènia Santacana;Lorena Rodríguez-Alonso;Ariadna Padullés;Jordi Guardiola;Jordi Bas;Francisco Rodríguez-Moranta;Katja Serra;Francisco Morandeira;Helena Colom;Núria Padullés;
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1Department of Pharmacy, Hospital Universitari de Bellvitge-HUB. Pharmacotherapy, Pharmacogenetics and Pharmaceutical Technology Program, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain.2Department of Gastroenterology, Hospital Universitari de Bellvitge-HUB. L’Hospitalet de Llobregat, Barcelona, Spain.3Immunology, Hospital Universitari de Bellvitge-HUB. L’Hospitalet de Llobregat, Barcelona, Spain.4Pharmacy and Pharmaceutical Technology Department, Universitat de Barcelona-UB, Pharmacotherapy, Pharmacogenetics and Pharmaceutical Technology Program, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain.
Abstract
Treating patients based on a treat-to-trough approach has been shown to be a cost-effective strategy for inflammatory bowel disease (IBD) patients who have become unresponsive to infliximab (IFX). However, the documented evidence for this is limited, and some controversy remains regarding the use of routine proactive therapeutic drug monitoring (TDM). To support routine TDM of IFX and regimen optimization in IBD patients, more in-depth knowledge of the covariates that affect the pharmacokinetic (PK) variability of IFX is needed. The aim of this study was to identify the characteristics of the patient, disease, and treatments that influence IFX PK and exposure in our cohort of IBD patients using a repeated measures design.We performed a prospective observational study of adult IBD patients who received IFX between July 2013 and March 2017. We obtained repeated IFX trough concentration (Cmin) measurements and implemented a previously described population pharmacokinetic (PPK) model to estimate individual clearance (CL). From the individual primary parameters, the area under the curve (AUC), half-life (t1/2), and central elimination rate constant (K10) were estimated. We performed a repeated measures analysis to evaluate whether patient characteristics, disease status, concomitant immunosuppressive therapy, and immunogenicity are associated with IFX Cmin and PK parameters.We collected 429 Cmin measurements from 112 patients. The median of the Cmin values was 3.62 mg/L (1.47-6.02). Antibodies to IFX (ATI) were detected in 14 patients. The predicted median AUC was 28421 mg/h/L (22336-36903). The median individual predicted CL, K10, and t1/2 values were 4.77 mL/kg/day (3.88-5.90), 0.09 days-1 (0.08-0.12), and 12.22 days (9.49-14.87), respectively. IFX Cmin, AUC, CL, and K10 were significantly influenced by ATI and serum albumin concentrations. Moreover, body weight was significantly associated with AUC, CL, and K10. Patients receiving concurrent immunosuppressive therapy had higher Cmin and AUC values, and lower CL and K10 values, than those treated with IFX monotherapy. We also observed high intra-patient variability in Cmin values during the study period.In this repeated measures study in a population of IBD patients, we observed significant associations between ATI, serum albumin concentration, concomitant immunosuppressive therapy, body weight and gender, and IFX Cmin and CL. The high PK variability observed in this study supports the need for proactive TDM to optimize the use of IFX as early as possible in IBD patients.
