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Ward MG, Thwaites PA, Beswick L, Hogg J, Rosella G, Van Langenberg D, Reynolds J, Gibson PR, Sparrow MP. Intra-patient variability in adalimumab drug levels within and between cycles in Crohn's disease. Aliment Pharmacol Ther 2017; 45:1135-1145. [PMID: 28239869 DOI: 10.1111/apt.13992] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/26/2016] [Accepted: 01/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Whether therapeutic drug monitoring for adalimumab needs to be performed at trough has not been defined. AIM To determine intra-patient adalimumab drug-level variation and to identify modulating patient and disease factors. METHODS In this prospective observational study, adult patients with Crohn's disease established on maintenance adalimumab had drug levels measured repeatedly according to pre-defined schedules (visit 1: day 4-6, visit 2: day 7-9, trough: day 13-14) across two consecutive fortnightly cycles. Disease activity was assessed using Harvey-Bradshaw Index, C-reactive protein and faecal calprotectin. For this analysis, trough levels ≥4.9 μg/mL were considered therapeutic. RESULTS Nineteen patients underwent 111 evaluations. Mean intra-patient drug levels from paired visits between cycles did not differ (visit1 cycle1: 4.81, cycle2: 5.21 μg/mL, P = 0.24, visit2 cycle1: 4.86, cycle2: 4.82, P = 0.91 and trough cycle1: 3.95, cycle2: 3.95, P = 0.99), irrespective of disease activity. Drug levels were stable over the first 9 days (visit 1-2), but declined to trough by a mean 1.06 and 0.89 μg/mL between visit 1 or 2, respectively (P < 0.001). Models using nontemporal factors (smoking, syringe delivery device) and levels at earlier visits accounted for 66-80% of the variance in trough levels. On receiver-operating curve analysis, thresholds identified in the first 9 days that predicted a therapeutic trough level were similar to the trough threshold itself, with high sensitivity but modest specificity. CONCLUSION While therapeutic drug monitoring should be performed at trough, a drug level ≥4.9 μg/mL obtained during the first 9 days predicts a therapeutic trough drug level with reasonable confidence.
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Affiliation(s)
- M G Ward
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia.,Department of Gastroenterology, Eastern Health, Melbourne, Vic., Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - P A Thwaites
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - L Beswick
- Department of Gastroenterology, Eastern Health, Melbourne, Vic., Australia
| | - J Hogg
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - G Rosella
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - D Van Langenberg
- Department of Gastroenterology, Eastern Health, Melbourne, Vic., Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - J Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - P R Gibson
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - M P Sparrow
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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Costello SP, Ghaly S, Beswick L, Pudipeddi A, Agarwal A, Sechi A, O'Connor S, Connor SJ, Sparrow MP, Bampton P, Walsh AJ, Andrews JM. Compassionate access anti-tumour necrosis factor-α therapy for ulcerative colitis in Australia: the benefits to patients. Intern Med J 2016; 45:659-66. [PMID: 25732268 DOI: 10.1111/imj.12732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/25/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The efficacy of infliximab has been demonstrated in patients with both acute severe and moderate-severe ulcerative colitis (UC). However, there is a need for 'real-life data' to ensure that conclusions from trial settings are applicable in usual care. We therefore examined the national experience of anti-tumour necrosis factor-α (TNF-α) therapy in UC. METHODS Case notes review of patients with UC who had received compassionate access (CA) anti-TNF-α therapy from prospectively maintained inflammatory bowel disease databases of six Australian adult teaching hospitals. RESULTS Patients either received drug for acute severe UC (ASUC) failing steroids (n = 29) or for medically refractory UC (MRUC) (n = 35). In ASUC, the treating physicians judged that anti-TNF-α therapy was successful in 20/29 patients (69%); in these cases, anti-TNF-α was able to be discontinued (after 1-3 infusions in 19/20 responders) as clinical remission was achieved. Consistent with this perceived benefit, only 7/29 (24%) subsequently underwent colectomy during a median follow up of 12 months (interquartile range (IQR) 5-16). Eight of the 35 patients with MRUC (23%) required colectomy during a median follow up of 28 months (IQR 11-43). The majority of these patients (20/35 or 57%) had anti-TNF-α therapy for ≥4 months, whereas, 27/29 (93%) of ASUC patients had CA for ≤3 months. CONCLUSIONS These data show an excellent overall benefit for anti-TNF-α therapy in both ASUC and MRUC. In particular, only short-duration anti-TNF-α was required in ASUC. These real-life data thus support the clinical trial data and should lead to broader use of this therapy in UC.
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Affiliation(s)
- S P Costello
- Inflammatory Bowel Disease Service, Department of Gastroenterology and School of Medicine, University of Adelaide at Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - S Ghaly
- Department of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - L Beswick
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - A Pudipeddi
- Department of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - A Agarwal
- Inflammatory Bowel Disease Service, Department of Gastroenterology and School of Medicine, University of Adelaide at Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Sechi
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - S O'Connor
- Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - S J Connor
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - M P Sparrow
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - P Bampton
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - A J Walsh
- Department of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - J M Andrews
- Inflammatory Bowel Disease Service, Department of Gastroenterology and School of Medicine, University of Adelaide at Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Andrews JM, Costello SP, Agarwal AK, Bampton P, Beswick L, Connor S, Ghaly S, O'Connor S, Pudipeddi A, Sechi A, Sparrow M, Walsh AJ. Conflict of interest: real and perceived - a more mature consideration is needed. Intern Med J 2016; 46:377-9. [DOI: 10.1111/imj.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J. M. Andrews
- IBD Service, Department of Gastroenterology and Hepatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - S. P. Costello
- IBD Service, Department of Gastroenterology and Hepatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - A. K. Agarwal
- IBD Service, Department of Gastroenterology and Hepatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - P. Bampton
- Department of Gastroenterology; Flinders Medical Centre; Adelaide South Australia Australia
| | - L. Beswick
- Department of Gastroenterology; Barwon Health; Geelong Victoria Australia
| | - S. Connor
- Department of Gastroenterology; Liverpool Hospital; Liverpool New South Wales Australia
| | - S. Ghaly
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - S. O'Connor
- Department of Gastroenterology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - A. Pudipeddi
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - A. Sechi
- IBD Service; Liverpool Hospital; Liverpool New South Wales Australia
| | - M. Sparrow
- Department of Gastroenterology; Alfred Hospital; Melbourne Victoria Australia
| | - A. J. Walsh
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
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Ghaly S, Costello S, Beswick L, Pudipeddi A, Agarwal A, Sechi A, Antoniades S, Headon B, Connor S, Lawrance IC, Sparrow M, Walsh AJ, Andrews JM. Dose tailoring of anti-tumour necrosis factor-alpha therapy delivers useful clinical efficacy in Crohn disease patients experiencing loss of response. Intern Med J 2015; 45:170-7. [DOI: 10.1111/imj.12621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/02/2014] [Indexed: 12/22/2022]
Affiliation(s)
- S. Ghaly
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
- Centre for Inflammatory Bowel Disease; Fremantle Hospital; Fremantle Western Australia Australia
| | - S. Costello
- IBD Service; Department of Gastroenterology and Hepatology; School of Medicine; University of Adelaide at Royal Adelaide Hospital; Adelaide South Australia Australia
| | - L. Beswick
- Department of Gastroenterology; The Alfred Hospital; Melbourne Victoria Australia
| | - A. Pudipeddi
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - A. Agarwal
- IBD Service; Department of Gastroenterology and Hepatology; School of Medicine; University of Adelaide at Royal Adelaide Hospital; Adelaide South Australia Australia
| | - A. Sechi
- Department of Gastroenterology; Liverpool Hospital; University of NSW; Sydney New South Wales Australia
| | - S. Antoniades
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - B. Headon
- Department of Gastroenterology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Connor
- Department of Gastroenterology; Liverpool Hospital; University of NSW; Sydney New South Wales Australia
| | - I. C. Lawrance
- Centre for Inflammatory Bowel Disease; Fremantle Hospital; Fremantle Western Australia Australia
| | - M. Sparrow
- Department of Gastroenterology; The Alfred Hospital; Melbourne Victoria Australia
| | - A. J. Walsh
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - J. M. Andrews
- IBD Service; Department of Gastroenterology and Hepatology; School of Medicine; University of Adelaide at Royal Adelaide Hospital; Adelaide South Australia Australia
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Beswick L, Ting A, Macrae F, Dowling D, Hair C. Divergent understanding of health professionals regarding correct subsequent management of an asymptomatic patient with a positive faecal occult blood test and negative colonoscopy with resultant cost implications. Intern Med J 2014; 44:1264-5. [PMID: 25442767 DOI: 10.1111/imj.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- L Beswick
- Department of Gastroenterology, Barwon Health, Geelong, Victoria, Australia
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