Pharmacokinetics of Infliximab in Children with Moderate-to-Severe Ulcerative Colitis: Results from a Randomized, Multicenter, Open-label, Phase 3 Study

Background:To assess infliximab pharmacokinetics in pediatric ulcerative colitis (UC).Methods:This phase 3, randomized, open-label multicenter study enrolled 60 children (6-17 yr) with moderate-to-severely active UC (Mayo score, 6-12; endoscopic subscore, 2), despite conventional therapy. Patients received infliximab 5-mg/kg induction infusions at weeks 0, 2, and 6. Week 8 clinical responders (n = 45) were randomized to infliximab 5 mg/kg given every 8 weeks (q8w) through week 46 or every 12 weeks (q12w) through week 42. Patients losing response during maintenance infliximab were eligible to increase the dose (510 mg/kg) and/or shorten the dosing interval (q12wq8w). Blood samples were collected for infliximab concentration and pharmacokinetic determinations.Results:Infliximab pharmacokinetics were not influenced by age (6-11 yr versus 12-17 yr), baseline immunomodulator use, or the extent of UC. At week 8, higher serum infliximab concentrations (41.1 g/mL) were associated with greater proportions of patients achieving efficacy endpoints (clinical response, 92.9%; mucosal healing, 92.9%; and clinical remission, 64.3%) versus those with lower serum concentrations (<18.1 g/mL; 53.9%, 53.9%, and 30.8%, respectively). At week 30, higher median trough serum infliximab concentrations were observed with infliximab 5 mg/kg q8w (1.9 g/mL) versus q12w (0.8 g/mL) and with infliximab 10 mg/kg (2.9 g/mL) versus 5 mg/kg (1.1 g/mL) among patients who are regimen adjusted.Conclusions:Infliximab pharmacokinetics/exposure-response relationship in patients with UC aged 6 to 17 years were generally comparable with those observed in reference adult UC populations, supporting using infliximab 5 mg/kg at weeks 0, 2, and 6 followed by maintenance dosing with 5 mg/kg q8w in these patients. A positive relationship was noted between serum infliximab level and clinical effect following induction therapy similar to adults.