Inadequate infliximab drug exposure remains a clinical challenge and leads to high loss of response rates and therapy failure in inflammatory bowel disease (IBD).
Dr Travis Piester and colleagues determined the feasibility and pilot effectiveness of a novel, web-based, mobile infliximab dosing calculator for therapy optimization.
The researchers developed an mobile infliximab dosing calculator leveraging the known clinical variables of C-reative protein (CRP), albumin, patient’s weight, disease activity indices, calprotectin, drug trough levels, and antibodies to infliximab that significantly affect pharmacokinetics and/or outcomes.
A prospective observational cohort study in pediatric and young adult IBD patients receiving maintenance infliximab was performed.
System-wide practice adoption of mobile infliximab dosing calculator was achieved through a quality improvement (QI) initiative within a hospital-based infusion unit.
The team noted that 49 patients were followed over 9 months.
|Infliximab trough goal of >5 μg/mL was achieved with 81% probability throughout the QI initiative|
|Inflammatory Bowel Diseases|
Mobile infliximab dosing calculator recommendations for dose optimization were followed by the treating physicians in 89% of infusions.
The researchers noted that 13% of mobile infliximab dosing calculator recommendations were to escalate infliximab dosing.
The team noted that 54% of escalation recommendations were declined, and these patients were more likely to already be receiving infliximab dose intensification compared with those in whom escalation recommendations were followed.
From mobile infliximab dosing calculator initiation to end of follow-up, mean albumin levels remained unchanged at 3.8 g/dL.
The research team observed that the median CRP remained unchanged at 2 g/L.
Median calprotectin levels showed a downward trend from 30 to 27 μg/g.
The team found that the percentage of patients undergoing therapeutic drug monitoring in clinical care increased from 34% to 86% with the QI initiative.
The target median infliximab trough goal of >5 μg/mL was achieved with 81% probability throughout the QI initiative, an increase of 12% compared with pre-QI values.
Dr Piester's team concludes, "The use of a novel mobile infliximab dosing calculator is feasible and potentially effective, facilitating both standardization and individualization of therapy in clinical care."
"Mobile infliximab dosing calculator appears to be a practical infliximab dosing tool for point-of-care use, leveraging individual pharmacokinetic considerations."