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Factors associated with reduced infliximab exposure in the treatment of pediatric autoimmune disorders: a cross-sectional prospective convenience sampling study.

Publication ,  Journal Article
Funk, RS; Shakhnovich, V; Cho, YK; Polireddy, K; Jausurawong, T; Gress, K; Becker, ML
Published in: Pediatr Rheumatol Online J
May 1, 2021

BACKGROUND: Inadequate systemic exposure to infliximab (IFX) is associated with treatment failure. This work evaluated factors associated with reduced IFX exposure in children with autoimmune disorders requiring IFX therapy. METHODS: In this single-center cross-sectional prospective study IFX trough concentrations and anti-drug antibodies (ADAs) were measured in serum from children diagnosed with inflammatory bowel disease (IBD) (n = 73), juvenile idiopathic arthritis (JIA) (n = 16), or uveitis (n = 8) receiving maintenance IFX infusions at an outpatient infusion clinic in a tertiary academic pediatric hospital. IFX concentrations in combination with population pharmacokinetic modeling were used to estimate IFX clearance. Patient demographic and clinical data were collected by chart review and evaluated for their relationship with IFX clearance. RESULTS: IFX trough concentrations ranged from 0 to > 40 μg/mL and were 3-fold lower in children with IBD compared to children with JIA (p = 0.0002) or uveitis (p = 0.001). Children with IBD were found to receive lower IFX doses with longer dosing intervals, resulting in dose intensities (mg/kg/day) that were 2-fold lower compared to children with JIA (p = 0.0002) or uveitis (p = 0.02). Use of population pharmacokinetic analysis to normalize for variation in dosing practices demonstrated that increased IFX clearance was associated with ADA positivity (p = 0.004), male gender (p = 0.02), elevated erythrocyte sedimentation rate (ESR) (p = 0.02), elevated c-reactive protein (CRP) (p = 0.001), reduced serum albumin concentrations (p = 0.0005), and increased disease activity in JIA (p = 0.009) and IBD (p ≤ 0.08). No significant relationship between diagnosis and underlying differences in IFX clearance was observed. Multivariable analysis by covariate population pharmacokinetic modeling confirmed increased IFX clearance to be associated with anti-IFX antibody positivity, increased ESR, and reduced serum albumin concentrations. CONCLUSIONS: Enhanced IFX clearance is associated with immunogenicity and inflammatory burden across autoimmune disorders. Higher systemic IFX exposures observed in children with rheumatologic disorders are driven primarily by provider drug dose and interval selection, rather than differences in IFX pharmacokinetics across diagnoses. Despite maintenance IFX dosing at or above the standard recommended range for IBD (i.e., 5 mg/kg every 8 weeks), the dosing intensity used in the treatment of IBD is notably lower than dosing intensities used to treat JIA and uveitis, and may place some children with IBD at risk for suboptimal maintenance IFX exposures necessary for treatment response.

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Published In

Pediatr Rheumatol Online J

DOI

EISSN

1546-0096

Publication Date

May 1, 2021

Volume

19

Issue

1

Start / End Page

62

Location

England

Related Subject Headings

  • Uveitis
  • United States
  • Tumor Necrosis Factor Inhibitors
  • Pediatrics
  • Metabolic Clearance Rate
  • Male
  • Infliximab
  • Inflammatory Bowel Diseases
  • Humans
  • Female
 

Citation

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ICMJE
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Funk, R. S., Shakhnovich, V., Cho, Y. K., Polireddy, K., Jausurawong, T., Gress, K., & Becker, M. L. (2021). Factors associated with reduced infliximab exposure in the treatment of pediatric autoimmune disorders: a cross-sectional prospective convenience sampling study. Pediatr Rheumatol Online J, 19(1), 62. https://doi.org/10.1186/s12969-021-00548-8
Funk, Ryan S., Valentina Shakhnovich, Yu Kyoung Cho, Kishore Polireddy, Taina Jausurawong, Kyle Gress, and Mara L. Becker. “Factors associated with reduced infliximab exposure in the treatment of pediatric autoimmune disorders: a cross-sectional prospective convenience sampling study.Pediatr Rheumatol Online J 19, no. 1 (May 1, 2021): 62. https://doi.org/10.1186/s12969-021-00548-8.
Funk RS, Shakhnovich V, Cho YK, Polireddy K, Jausurawong T, Gress K, et al. Factors associated with reduced infliximab exposure in the treatment of pediatric autoimmune disorders: a cross-sectional prospective convenience sampling study. Pediatr Rheumatol Online J. 2021 May 1;19(1):62.
Funk, Ryan S., et al. “Factors associated with reduced infliximab exposure in the treatment of pediatric autoimmune disorders: a cross-sectional prospective convenience sampling study.Pediatr Rheumatol Online J, vol. 19, no. 1, May 2021, p. 62. Pubmed, doi:10.1186/s12969-021-00548-8.
Funk RS, Shakhnovich V, Cho YK, Polireddy K, Jausurawong T, Gress K, Becker ML. Factors associated with reduced infliximab exposure in the treatment of pediatric autoimmune disorders: a cross-sectional prospective convenience sampling study. Pediatr Rheumatol Online J. 2021 May 1;19(1):62.
Journal cover image

Published In

Pediatr Rheumatol Online J

DOI

EISSN

1546-0096

Publication Date

May 1, 2021

Volume

19

Issue

1

Start / End Page

62

Location

England

Related Subject Headings

  • Uveitis
  • United States
  • Tumor Necrosis Factor Inhibitors
  • Pediatrics
  • Metabolic Clearance Rate
  • Male
  • Infliximab
  • Inflammatory Bowel Diseases
  • Humans
  • Female