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CP-104 Infliximab utilisation study in a tertiary paediatric hospital
  1. F Bossacoma Busquets1,
  2. J Arrojo Suárez1,
  3. A Comes Escoda1,
  4. M Sánchez Celma1,
  5. G Pujol Muncunill2,
  6. FJ Martín de Carpi2,
  7. J Anton López3,
  8. M Villaronga Flaqué1
  1. 1Hospital Sant Joan de Déu, Pharmacy, Esplugues de Llobregat, Spain
  2. 2Hospital Sant Joan de Déu, Gastroenterology, Esplugues de Llobregat, Spain
  3. 3Hospital Sant Joan de Déu, Rheumatology, Esplugues de Llobregat, Spain

Abstract

Background Infliximab is a monoclonal antibody to tumour necrosis factor, approved in paediatric patients for moderate–severe inflammatory bowel disease (IBD)—both Crohn’s disease (CD) and ulcerative colitis (UC). Induction regimen consists of 5 mg/kg dose given at weeks 0, 2 and 6, followed by a maintenance regimen of 5 mg/kg every 8 weeks. An intensification strategy, increase in dose, decrease in interval infusions or both is suggested for treatment failure.

Purpose To describe the patterns of infliximab use in a tertiary paediatric hospital.

Material and methods This was a cross sectional study including all patients treated with infliximab in a maintenance regimen. The variables analysed were: age, prescribing service, indication, and dosing and interval infusions.

Results 46 patients were analysed with a median age of 15 years (4–19). Label indications were 37 patients with IBD: CD (21/46) and UC (16/46). Off-label indications supported by clinical evidence were 9: juvenile idiopathic arthritis associated uveitis (JIA-U) (6/46); and others—idiopathic uveitis (1/46), Blau syndrome(1/46) and sarcoidosis(1/46). Mean adjusted monthly dose was 5.4 mg/kg, higher doses were prescribed in patients with a rheumatological diagnosis (8.4 mg/kg for JIA-U, 6.3 mg/kg for others), followed by UC (5.8 mg/kg) and CD (4.1 mg/kg). Infliximab interval was shortened in 25/46 patients. Analysed by indications: patients with UC (11/21), patients with CD (6/16), patients with JIA-U (6/6) and patients with other diseases(2/3). The dose was stepped up and the interval shortened in 15/46 patients.

Conclusion Infliximab in paediatrics is used mostly for labelled indications, UC and CD. Indications of infliximab prescribed as off-label treatment in our centre were for JIA-U, idiopathic uveitis, Blau syndrome and sarcoidosis. About half of patients were treated using an intensification strategy, higher doses and/or shortened interval infusions. The real dosage of infliximab is higher than the summaries of product characteristics dosage but high doses are reported in the literature as a good option to optimise treatment, and some studies recommend this option as a good way to prevent infliximab antibody formation. Further studies are necessary to clarify which is the best option to achieve a response using the minimum dose with maximum patient benefit.

No conflict of interest

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