Optimization of infliximab therapy in inflammatory bowel disease using a dashboard approach-an Indian experience
Optimization of infliximab therapy in inflammatory bowel disease using a dashboard approach-an Indian experience
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DOI：
10.1007/s00228-020-02975-0
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发表时间：
2020-08-15
影响因子：
2.9
通讯作者：
Ashavaid, Tester F.
中科院分区：
文献类型：
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作者：
Dave, Mihika B.;Dherai, Alpa J.;Ashavaid, Tester F.
由于复杂的药代动力学和免疫因素，英夫利昔单抗（IFX）治疗炎症性肠病（IBD）与一半患者的反应丧失相关。Dashboard的贝叶斯算法使用来自模型和IFX浓度的单个多变量决定因素的信息，可以预测剂量和给药间隔。目的比较实验室测量的IFX浓度与iDose仪表板系统预测的值，并报告其在管理对常规给药方案无反应的患者中的疗效。方法将2017年11月至2019年11月本实验室IFX药物监测IBD患者（n= 30，中位年龄23岁（IQR: 14.25 ~ 33.5））的临床病史、人口统计学资料及白蛋白、c反应蛋白（CRP）等实验室检查结果输入iDose软件。iDose基于此信息预测的IFX浓度与我们实验室的测量值进行了比较。此外，在这30名对常规剂量无反应的患者中，有11名患者采用了前瞻性仪表板指导剂量，并对其临床结果进行了跟踪评估。结果30例患者IFX监测显示治疗浓度12例，治疗超浓度2例，治疗亚浓度16例。iDose预测浓度在这30例患者中有21例显示一致。在11例使用碘辅助前瞻性给药的患者中，8例达到临床缓解，2例显示部分缓解，1例产生抗体。结论回顾性数据分析显示，70%的患者实验室测量的IFX水平与idose预测的IFX水平一致。药物辅助治疗达到了临床缓解和成本降低。
Purpose Infliximab (IFX) therapy in inflammatory bowel disease (IBD) is associated with loss of response in half the patients, due to complex pharmacokinetic and immunological factors. Dashboard's Bayesian algorithms use information from model and individual multivariate determinants of IFX concentration and can predict dose and dosing interval. Aim To compare measured IFX concentrations in our laboratory with values predicted by iDose dashboard system and report its efficacy in managing patients not responding to conventional dosing schedule. Method Clinical history, demographic details, and laboratory findings such as albumin and C-reactive protein (CRP) data of IBD patients (n= 30; median age 23 years (IQR: 14.25 - 33.5)) referred for IFX drug monitoring in our laboratory from November 2017 to November 2019 were entered in iDose software. The IFX concentration predicted by iDose based on this information was compared with that measured in our laboratory. In addition, a prospective dashboard-guided dosing was prescribed in 11 of these 30 patients not responding to conventional dosing and was followed to assess their clinical outcome. Result IFX monitoring in our 30 patients had shown therapeutic concentration in 12, supratherapeutic in 2 and subtherapeutic concentration in 16 patients. The iDose predicted concentration showed concordance in 21 of these 30 patients. Of 11 patients managed with iDose-assisted prospective dosing, 8 achieved clinical remission, 2 showed partial response, and one developed antibodies. Conclusion Retrospective data analysis showed concordance between laboratory measured and iDose-predicted IFX level in 70% of patients. iDose-assisted management achieved clinical remission and cost reduction.