Higher infliximab concentrations tied to better outcomes in paediatric CD

Higher concentrations of infliximab postinduction results in favourable clinical outcomes in paediatric patients with Crohn’s disease (CD) both in the short and long term, reports a study.

Exposure-outcome relationship data demonstrate better outcomes with higher infliximab concentrations among CD patients, but these data were mostly obtained from adult patients on maintenance therapy. This study sought to examine the relationship of infliximab concentrations during and early after induction therapy of infliximab with short- and long-term clinical outcomes in paediatric patients.

The investigators performed a post hoc analysis of the REACH trial, which included 103 paediatric patients with moderate-to-severe CD who received infliximab.

The following outcomes were assessed: early clinical remission (CR), defined as paediatric CD activity index score of ≤10, assessed at week 10, and long-term clinical response (LTCR), defined as a decrease from baseline in the paediatric CD activity index score of at least 15 points, with a total score of ≤30 and no need for drug discontinuation, assessed at weeks 30 and 54.

Multivariate analysis revealed that higher week 10 infliximab concentration independently correlated with CR at week 10 (odds ratio [OR], 1.54, 95 percent confidence interval [CI], 1.06‒2.22; p=0.022) and LTCR at week 30 (OR, 1.62, 95 percent CI, 1.12‒2.36; p=0.010).

On receiver operating characteristic analysis, week 10 infliximab concentration thresholds of ≥7.1 μg/mL and ≥6.5 μg/mL were associated with CR at week 10 and LTCR at week 30, respectively.

“Tailoring dosing during induction to achieve higher infliximab exposure may lead to better outcomes in paediatric patients with CD,” the investigators said.