Subcutaneous infliximab roughly doubled drug levels in children with IBD; drug-linked cerebral vasoconstriction clusters within days of starting

The edition in brief

A meta-analysis of five observational cohorts (162 children with inflammatory bowel disease, median follow-up about 6 months) found that after a switch from intravenous to subcutaneous infliximab, persistence was 89.8% and clinical remission about 90%, mean serum infliximab roughly doubled (11.4 to 21.9 micrograms per mL) and new antidrug antibodies were rare (0.7%); certainty was low to very low and almost all children switched while in remission. A VigiBase case-non-case study of 735 CNS vasculitis and 1,553 reversible cerebral vasoconstriction cases found vasculitis linked mainly to immune checkpoint inhibitors and propylthiouracil (median onset about 36 days), and vasoconstriction to triptans, ergots, SSRIs and cannabis with a median onset of about 9 days, plus a new signal for teprotumumab based on six reports. A French sequence symmetry analysis of 36,163 PCSK9 inhibitor initiators compared with ezetimibe found only two signals, both attributed to bias or confounding. In children, lithium reports in VigiBase showed proportionally more renal, endocrine and gastrointestinal reactions than reports for second-generation antipsychotics. The FDA database shows a supplement dated 24 September for lenvatinib, with no detail on what changed.