UH Rainbow Using Personalized Medicine Tool to Better Manage Kids and Teens with Irritable Bowel Disease

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Program helps personalize dosing for infliximab

Innovations in Pediatrics | Fall 2019

Jonathan Moses, MD Jonathan Moses, MD

Infliximab (Remicade) is a mainstay of treatment for children and teens with inflammatory bowel disease (IBD), whether they have Crohn’s disease or ulcerative colitis.

“The medicine has a standard schedule of dosing that we give to everybody, a rate of infusion at set periods of time,” says Jonathan Moses, MD, a pediatric gastroenterologist at UH Rainbow Babies & Children’s Hospital; and Assistant Professor of Pediatrics, Case Western Reserve University School of Medicine. “Based on the studies that have been done, there’s an approved standard dose of 5 milligrams per kilogram.”

However, Dr. Moses says, over the last 10 years, pediatric gastroenterologists like himself have discovered that this dose likely isn’t sufficient for every patient.

“We may be under-dosing when it comes to infliximab,” he says. “Most commonly we’ll check the level after the first three doses and before the fourth dose. But we’re finding is that it’s probably too late and you may be losing response.”

To address this issue, Dr. Moses and his colleagues in the Division of Pediatric Gastroenterology at UH Rainbow are collaborating with a clinical decision-support company called InsightRx to test, use and validate a more precise, personalized method of determining the best infliximab dose for each individual patient.

“The idea with this personalized medicine approach is to have a program that you can plug characteristics in for the patient – gender, some of their lab values, what medicines they’re on,” he says. “It can predict the exact dose you should give them so that they achieve the appropriate level at a set period of time. The idea is that this program will actually individualize how patients process the medicine, because everybody does it differently, so that everybody gets the right amount of medicine and has the right level when they’re done with the induction phase.”

The program incorporates measures of inflammation, as well as the patient’s albumin level, Dr. Moses says.

“We get a sense of how leaky the intestines are based on this value,” he says. “If it’s really low, that indicates that the gut is leaky and the medicine will ’leak’ out of the body. It’s a marker of that.”

Dr. Moses says he’s enthusiastic about the program’s potential benefits for his patients, as well as the opportunity to test its applicability in a real-world setting with patients.

“We’ll be looking at patients who are actually on the medicine to see if their prediction model was correct,” he says. “We can provide them with that real-world data. We’ll see if it it’s validated or what adjustments they can make to make it a more accurate model in terms of giving the right amount of medicine.” 

“We want to make sure that everyone gets the exact, effective dose, neither too much nor too little, without having too many side effects,” he adds. “Giving the effective dose up front gives the kid what they need right away. It’s a really cool concept. We can personalize medicines for kids to deliver the best therapy possible.”

For more information about the use of personalized medicine in the treatment of IBD at UH Rainbow, call 216-553-1947 or email Peds.Innovations@UHhospitals.org.

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