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Individualized Infliximab Treatment Guided by Patient-managed eHealth in Children and Adolescents with Inflammatory Bowel Disease

Carlsen, Katrine MD*; Houen, Gunnar MSc, PhD, DSc; Jakobsen, Christian MD, PhD*; Kallemose, Thomas MSc; Paerregaard, Anders MD, DMSc*; Riis, Lene B. MD, PhD§; Munkholm, Pia MD, DMSc; Wewer, Vibeke MD, PhD*

doi: 10.1097/MIB.0000000000001170
IBD LIVE Articles

Background: To individualize timing of infliximab (IFX) treatment in children and adolescents with inflammatory bowel disease (IBD) using a patient-managed eHealth program.

Methods: Patients with IBD, 10 to 17 years old, treated with IFX were prospectively included. Starting 4 weeks after their last infusion, patients reported a weekly symptom score and provided a stool sample for fecal calprotectin analysis. Based on symptom scores and fecal calprotectin results, the eHealth program calculated a total inflammation burden score that determined the timing of the next IFX infusion (4–12 wk after the previous infusion). Quality of Life was scored by IMPACT III. A control group was included to compare trough levels of IFX antibodies and concentrations and treatment intervals. Patients and their parents evaluated the eHealth program.

Results: There were 29 patients with IBD in the eHealth group and 21 patients with IBD in the control group. During the control period, 94 infusions were provided in the eHealth group (mean interval 9.5 wk; SD 2.3) versus 105 infusions in the control group (mean interval 6.9 wk; SD 1.4). Treatment intervals were longer in the eHealth group (P < 0.001). Quality of Life did not change during the study. Appearance of IFX antibodies did not differ between the 2 groups. Eighty percent of patients reported increased disease control and 63% (86% of parents) reported an improved knowledge of the disease.

Conclusions: Self-managed, eHealth-individualized timing of IFX treatments, with treatment intervals of 4 to 12 weeks, was accompanied by no significant development of IFX antibodies. Patients reported better control and improved knowledge of their IBD.

Article first published online 14 June 2017.

*Department of Pediatrics, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark;

Department of Auto-immunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark;

Department of Orthopaedic Surgery, Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark;

§Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev, Denmark; and

Department of Gastroenterology, Danish Centre for eHealth & Epidemiology, North Zealand Hospital, University of Copenhagen, Frederikssund, Denmark.

Address correspondence to: Katrine Carlsen, MD, Department of Pediatrics, Hvidovre Hospital, University of Copenhagen, Kettegaard allé 30, 2650 Hvidovre, Denmark (e-mail: katrinec@gmail.com).

Supported by the European Crohn's and Colitis Organization, Queen Louise's Hospital Foundation, Tryg Foundation, CALPRO A/S, Tillotts Pharma, Capital Region Denmark, Alice and Frimodts Foundation, Ulcerative Colitis and Crohn's Danish Patient Society, MSD, and Promonitor/Orion Diagnostica.

K. Carlsen: Research grant MSD; research grant Tillotts pharma. V. Wewer: Advisory Board and research grant MSD Denmark; research grant Tillotts pharma. A. Paerregaard: Advisory Board Nestle; Speaker fee (2015) Abbvie. The remaining authors have no conflict of interest to disclose.

Received March 09, 2017

Accepted April 17, 2017

© Crohn's & Colitis Foundation
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