20 research outputs found

    Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance

    No full text
    BACKGROUND: Infliximab (IFX) is indicated for the treatment of inflammatory bowel diseases (IBD). Nevertheless, loss of response (LOR) to IFX is reported in up to 10% to 30% of patients within the first year of treatment. Our objective was to evaluate the impact of the pharmacokinetics of IFX at induction on treatment failure. METHODS: This is a longitudinal cohort study on 269 patients with IBD treated with IFX in a single center. A total of 2331 blood samples were prospectively collected from 2007 until March 2015 with a retrospective analysis of clinical data. IFX trough levels (TLs) were measured by enzyme-linked immunosorbent assay. Antibodies to IFX were measured by drug-sensitive bridging assay. RESULTS: During follow-up, patients were defined according to treatment outcome. At week 6, median IFX TL in patients requiring a switch to another treatment due to LOR (LOR switched group) (2.32 ÎĽg/mL [0.12-19.93 ÎĽg/mL]) was lower than in patients with long-term response (long-term responders) (8.66 ÎĽg/mL [0.12-12.09 ÎĽg/mL], P = 0.007) and in patients responding to optimization (LOR optimized group) (7.28 ÎĽg/mL [0.17-14.91 ÎĽg/mL], P = 0.021). At week 2, median IFX TL was lower in the LOR switched group (5.7 ÎĽg/mL [0.15-12.09 ÎĽg/mL]) compared with the long-term responders (11.92 ÎĽg/mL [0.14-19.93 ÎĽg/mL], P = 0.041) but no significant difference was reached with the LOR optimized group (11.91 ÎĽg/mL [0.23-12.09 ÎĽg/mL], P = 0.065). In the LOR switched group, median IFX TL at induction (weeks 2 and 6) was significantly lower when patients had been previously exposed to anti-tumor necrosis factor compared with naive patients (0.91 ÎĽg/mL [0.12-4.4 ÎĽg/mL] versus 6.6 ÎĽg/mL [0.15-19.93 ÎĽg/mL], P = 0.044). CONCLUSIONS: This study suggests that patients who do not respond to any optimization strategy have lower IFX TLs during induction at week 6. IFX TLs measured early on at induction might predict treatment failure to IFX during maintenance.status: publishe

    The transition to preschool: a problem or an opportunity for children? A sociological perspective in the context of a 'split system'

    No full text
    This paper discusses the central issue of the transition to preschool. Individual semi-structured interviews with school professionals and parents in the Brussels region revealed that this issue is crucial for the wellbeing of young children, from both an educational and a social perspective. We discovered that the education system works under the assumption that nearly every child has attended daycare before entering preschool. This has serious implications since using these services, which help to prepare children for preschool, is socially differentiated. Children who have to cope with their first socialization outside the family environment and their first encounter with the school environment at the same time face many problems. Not only does it define their first school experience; more importantly, it contributes to shape their entire experience of preschool, with potential long-term harmful effects. The paper discusses the corresponding implications for the school system and puts forward recommendations.Cet article traite de la question centrale de la transition vers l’école maternelle. Au travers d’entretiens semi-directifs, menés auprès de professionnels et de parents en région bruxelloise, cette question est apparue comme cruciale pour le bien-être des jeunes enfants, sur les plans éducatif et social. Comme nous l’avons constaté, l’institution scolaire fonctionne sur l’idée d’un recours quasi-systématique aux milieux d’accueil pour les enfants avant l’entrée en maternelle. Les implications sont lourdes puisque l’utilisation des milieux d’accueil, qui préparent les enfants à l’école maternelle, est en réalité socialement différenciée. Les défis se superposent donc pour ces enfants qui découvrent simultanément la socialisation en dehors du milieu familial et l’environnement scolaire. Plus que la période d’entrée à l’école maternelle, les effets potentiellement néfastes de cette transition peuvent toucher les enfants durablement au travers de l’ensemble de l’expérience scolaire. Les implications pour le système scolaire sont discutées et des recommandations sont proposées.info:eu-repo/semantics/publishe
    corecore