PhD Defence Nanja Christel Bevers

Keywords: Paediatric Inflammatory Bowel Disease, Shared Decision-Making, Therapeutic Drug Monitoring, Fatigue 
 

"Interdisciplinary research to support shared decision-making in paediatric inflammatory bowel disease"
 

Paediatric inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are chronic conditions with increasing incidence and a more aggressive course than adult-onset IBD. This thesis emerged from clinical encounters with young patients and their families, aiming to answer key therapeutic questions and support shared decision-making through interdisciplinary research. 

Key findings include: 

• Anti-TNF Optimization: Measuring infliximab levels at week 14 (target ≥6.9 mg/L) better predicted sustained remission than earlier measurements. Pharmacokinetic modeling (Fasanmade et al.) combined with Bayesian forecasting improved treatment precision.
• Thiopurine Safety: TPMT testing prior to azathioprine (AZA) treatment is critical. Even TPMT-deficient patients can be managed safely with therapeutic drug monitoring and close clinical supervision.
• Iron Supplementation: In the POPEYE trial, intravenous iron showed faster improvement in physical fitness (after one month) compared to oral iron, though this effect equalized by three months. Haematological responses were similar across both methods.
• Guiding Iron Therapy: Hepcidin proved more accurate than traditional markers in predicting non-response to iron therapy, offering a better tool for timing treatment.
• Fatigue in IBD: Common biomarkers did not distinguish fatigued from non-fatigued patients. However, triaxial accelerometry showed potential in identifying fatigue-related physical activity patterns. 

This thesis highlights how collaborative research among clinicians, pharmacologists, chemists, and physiotherapists can enhance individualized care and evidence-based decision-making in paediatric IBD.

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