IBD
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See the full rubric →Prior adalimumab exposure alters infliximab pharmacokinetics and trough targets in pediatric Crohn's disease.
Clinical takeawayIn children with CD and prior adalimumab exposure starting infliximab, lower trough levels should be anticipated and more frequent dose escalation is likely needed. Monitor trough levels closely, expect to intensify dosing sooner than in biologic-naive patients, and recognize that remission remains achievable despite lower observed levels.
What it foundIn 469 children with CD, those with prior adalimumab exposure had lower mean infliximab trough levels (4.73 vs 6.19 µg/mL, P=.003), more frequently required dose intensification (41.2% vs 35.2%, P=.001), yet achieved comparable 1-year endoscopic remission rates (58.8% vs 61.3%, not significant).
ContextStandard practice applies uniform infliximab trough targets. This finding suggests prior biologic exposure alters pharmacokinetics and the exposure-response relationship, refining dosing strategy based on treatment history rather than using fixed targets across all patients.
No standard claimed for this paper
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Kwon Y … Kim MJ · Inflammatory Bowel Diseases · IF 4.5 · PubMed ↗