Remicade trough level

[kernelmom3]

Hi all, waiting for DD’s scope tomorrow on pins and needles and her Remicade level just came back at 34 with no antibodies. She’s currently 7.5/mg every 8 weeks and the labs were drawn last week so she was about halfway between infusions. Her level has always been between 15-34 but I just now stopped to wonder (because I’m wondering about everything right now with the scope tomorrow)…can Remicade levels be TOO high? All other labs look good except a slightly low albumin (which tends to dip every once in awhile). I don’t know too much about the Prometheus Anser and Monitr tests (Monitr isn’t back yet) so just thought I’d see if someone does. Thanks!

 

[Scipio]

34 would be quite high for a trough reading, but your daughter is not at trough. Trough is immediately before an infusion, and peak is immediately after an infusion. This Remicade measurement was done was at the mid-point between trough and peak - as you said, halfway between infusions.

I don't know whether 34 is high or low or just right for a midpoint, since measurements are normally done at trough. When people talk about a Remicade of say 3 being low or 12 being high, they are talking about trough measurements. Perhaps the doc is trying to "predict" what the trough level will be based on the midpoint level. There are some experimental software algorithms out now that claim to be able to do that, but I don't know how well they actually work.

As for your question about whether it is possible for Remicade level to be too high, the answer is yes, sort of. If 34 really were a trough concentration it would be "too high" in the sense that it is wastefully a lot higher than it needs to be to achieve the full therapeutic benefit. But it probably wouldn't be too high in the sense of being a toxic overdose, because the research publications have shown that the toxicity of Remicade is thankfully pretty low. So overshooting on the dosing is probably not very harmful.

 

[kernelmom3]

34 would be quite high for a trough reading, but your daughter is not at trough. Trough is immediately before an infusion, and peak is immediately after an infusion. This Remicade measurement was done was at the mid-point between trough and peak - as you said, halfway between infusions.

I don't know whether 34 is high or low or just right for a midpoint, since measurements are normally done at trough. When people talk about a Remicade of say 3 being low or 12 being high, they are talking about trough measurements. Perhaps the doc is trying to "predict" what the trough level will be based on the midpoint level. There are some experimental software algorithms out now that claim to be able to do that, but I don't know how well they actually work.

As for your question about whether it is possible for Remicade level to be too high, the answer is yes, sort of. If 34 really were a trough concentration it would be "too high" in the sense that it is wastefully a lot higher than it needs to be to achieve full therapeutic benefit. But it probably wouldn't be too high in the sense of being a toxic overdose, because the research publications have shown that the toxicity of Remicade is thankfully pretty low. So overshooting on the dosing is probably not very harmful.

Thank you so much for that awesome explanation, that makes so much sense! I feel dumb now because even though I knew they tested at the halfway point this time I wasn’t factoring that in!

 

[Jo-mom]

Very interesting. I think though that her levels are probably on the high side lthough this would not be an accurate reading as indicated by Scipio. In my son's case, his doctor likes to see trough levels around 7 to 10. I wonder how much that 34 would drop by in 4 weeks. I've always wondered how how those readings were at the peak or mid-way like DD's. She has no antibodies so that's good!

 

[kernelmom3]

Very interesting. I think though that her levels are probably on the high side lthough this would not be an accurate reading as indicated by Scipio. In my son's case, his doctor likes to see trough levels around 7 to 10. I wonder how much that 34 would drop by in 4 weeks. I've always wondered how how those readings were at the peak or mid-way like DD's. She has no antibodies so that's good!

Her level right before infusion is usually right between 15-19 (I checked the past results against her infusion dates). We’re on our way to the scope this morning..it was a LONG night!

 

[Maya142]

Any news?

 

[kernelmom3]

Thanks for checking in! Doc said the scope looked good and she is still in remission YAY! They also took biopsies so we’ll wait for those too. She had a very tiny internal hemorrhoid so that is probably the cause of the intermittent bleeding. Her heart rate dropped a bit when they were moving through a certain part of her colon so they had to give her Atropine. I guess it was a vasovagal response but it was still scary to hear. She now has a canker sore on her bottom lip and I don’t know if that’s from the guard they put in for the upper endoscopy or just a coincidence but we’ll keep an eye on it. Never a dull moment but SO grateful for the good news! Two down (DS and DD) and now I have to convince DH to go get another scope since he started Stelara.

 

[Maya142]

I have two kids with inflammatory arthritis and my husband has it too. He is by far the hardest one to convince to do the necessary tests and even take his biologic shots . Glad to know it’s not just my DH lol.
So glad your DD is in remission!