Induction-phase infliximab monitoring accelerates time to remission in pediatric IBD: a retrospective cohort study.

Abstract

Background: In pediatric inflammatory bowel disease (IBD), the optimal timing to begin therapeutic drug monitoring (TDM) of infliximab (IFX) is unclear. We hypothesized that TDM during induction of IFX improves clinical outcomes in children with IBD.

Methods: This retrospective cohort study utilized data from an internal database at Nationwide Children's Hospital between January 1, 2020, and December 31, 2023. Pediatric IBD patients receiving IFX with induction-phase TDM (I-TDM) at Week 6 were compared to those with maintenance-phase TDM (M-TDM) at Week 14. Propensity score matching (PSM) was used for sex, disease, and age at IFX start. The primary outcome was time to clinical remission.

Results: In total, 68 patients were matched from each group. The I-TDM group experienced a shorter median time to clinical remission (140 days [95% CI: 108, 167]) compared to the M-TDM group (203 days [95% CI: 167, 232]; P = .006). When adjusting for baseline variations, I-TDM remained independently associated with accelerated clinical remission (aHR = 1.68, 95% CI: 1.10, 2.55; P = .016). While time to therapeutic maintenance IFX levels was similar, post hoc analysis showed that 75% of patients in the I-TDM group achieved target levels in 134 days (95% CI: 114, 182) versus 183 days (95% CI: 153, 224) in the M-TDM group. There were no significant differences in long-term complications between the groups.

Conclusions: Induction-phase TDM before the third infusion shortens the time to clinical remission, allowing for more prompt dose adjustments and improving patient outcomes. This approach warrants consideration in clinical practice for children with IBD.