M Gibson et al. JPGN 2023; 77: 207-213. Safety and Durability of Accelerated Infliximab Dosing Strategies in Pediatric IBD: A Single Center, Retrospective Study

This pediatric retrospective study (n=291, 2010-2020) showed a high response to infliximab in patients with inflammatory bowel disease (n=234 Crohn’s disease (CD), n=53 ulcerative colitis (UC)) over a 10-period. Mean duration of treatment among study participants was 2.9 years. Key findings:

• 53% (n=135) started with doses of 10 mg/kg and 64% (n=87) of those who started on 5 mg/kg were dose-escalated; thus, approximately 76% of patients in their cohort needed doses of 10 mg/kg.
• Only 12% of patients discontinued treatment over the observed timeframe.
• Patients with UC (P ≤ 0.01) and patients with extensive disease (P = 0.01) had lower durability, despite a higher starting dose of IFX (P = 0.03).  Figure 2 indicated that durability in CD was ~93% compared to ~60% for UC with HR of 5.12. The HR for extensive disease (n=77) was 3.74 compared to those with limited disease (n=108). Still, ~75% of those with extensive disease continued on treatment
• Common adverse events included 18 with skin findings (14 with psoriasis, 3 nonspecific rash, 1 with lupus), 23 with infusion reactions, 7 with AST/ALT >3 times ULN (or >120 IU/L), and 3 with serious infections.

Like the theme song from the 1996 Olympics (Reach, Gloria Estefan) reaching higher (dosing) resulted in being stronger (i.e.. better outcomes).

My take: This study showed really good outcomes associated with “accelerated” infliximab dosing.

Related blog posts:

• Another Study Justifying Higher Infliximab Dosing in Pediatrics
• Disease extent and need for higher infliximab dosing
• ARCH Study: Higher Doses of Infliximab in Acute Severe Ulcerative Colitis
• How Much Infliximab Can You Give to Young Children?
• “Denials, Dilly-dallying and Despair”
• Kids Are Different: Therapeutic Drug Monitoring
• Can Therapeutic Drug Monitoring with Monotherapy Achieve Similar Results as Combination Therapy?

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