Proactive monitoring of anti-TNF agents improves follow-up of paediatric patients with Crohn disease

• Published in: Anales de Pediatría 2023-03, Vol.98 (3), p.165-174
• Main Authors: Rodríguez Azor, Begoña, Martín-Masot, Rafael, Dayaldasani Khialani, Anita, Fernández-Martín, Jesús María, Gallego Fernández, Carmen, Navas-López, Víctor Manuel
• Format: Article
• Language: English
• Subjects: Adalimumab; Anti-Inflammatory Agents - therapeutic use; Child; Crohn Disease - diagnosis; Crohn Disease - drug therapy; Enfermedad de Crohn pediátrica; Enfermedad inflamatoria intestinal; Female; Follow-Up Studies; Humans; Inflammatory bowel disease; Infliximab; Male; Monitorización de fármacos; Paediatric Crohn disease; Prospective Studies; Therapeutic drug monitoring; Treatment Outcome; Tumor Necrosis Factor Inhibitors - therapeutic use
• ISSN: 2341-2879; 2341-2879
• DOI: 10.1016/j.anpede.2023.01.007

[Display omitted] The incidence of paediatric inflammatory bowel disease has increased in recent decades. The aim of the present study was to evaluate the role of proactive and serial monitoring of tumour necrosis factor (TNF) inhibitor levels to maintain clinical remission and mucosal healing in the follow-up of paediatric patients with Crohn disease (CD). Prospective study that included all patients diagnosed with CD and treated with adalimumab or infliximab between May 2015 and November 2020 who underwent serial and proactive monitoring of TNF inhibitor levels. The study included 30 patients, 21 male (70%). The mean age at diagnosis was 11.3 years (SD, 2.0), the mean age at initiation of TNF inhibitors was 12.6 years (SD, 1.9) with a mean duration of follow-up of 27.1 ± 9.1 months. Clinical remission was defined as a weighted Pediatric Crohn’s Disease Activity Index (wPCDAI) of less than 12.5 and mucosal healing as a Mucosal Inflammation Non-invasive Index (MINI) of less than 8. During the follow-up, patients were in clinical remission in 87.1% of the visits, presented with mild disease in 11.4% and with moderate disease in 1.5%, and mucosal healing was assumed in 83% of the visits. The rates of clinical remission and mucosal healing at 1, 2, and 3 years of follow-up were 83.3%, 95.8%, 92.8%, and 86.7%, 87.5% and 85.7%, respectively. Proactive and serial monitoring of serum TNF inhibitor levels may make it possible for patients to maintain clinical remission and mucosal healing in the maintenance phase, with individualised optimization of the required dosage and minimization of secondary loss of response. La incidencia de la enfermedad inflamatoria intestinal pediátrica ha aumentado en las últimas décadas. El objetivo del presente estudio fue evaluar el papel de la monitorización proactiva y en serie de los niveles de fármacos anti-TNF (factor de necrosis tumoral) para mantener la remisión clínica y la curación mucosa durante el seguimiento de pacientes pediátricos con Enfermedad de Crohn (EC). Estudio prospectivo que incluye a todos los pacientes diagnosticados de EC y tratados con adalimumab o infliximab entre mayo de 2015 y noviembre de 2020, en los que se ha realizado una monitorización seriada y proactiva de los niveles de anti-TNF. Se incluyeron treinta pacientes, 21 varones (70%). La edad en el momento del diagnóstico fue de 11,3 ± 2,0, la edad en el momento de iniciar el anti-TNF fue de 12,6 ± 1,9 años con un tiempo medio de seguimiento de 27,1