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Review
. 2019 Jul;35(4):302-310.
doi: 10.1097/MOG.0000000000000536.

Therapeutic drug monitoring in inflammatory bowel disease: for every patient and every drug?

Konstantinos Papamichael  1 , Adam S Cheifetz
Affiliations
Review

Therapeutic drug monitoring in inflammatory bowel disease: for every patient and every drug?

Konstantinos Papamichael et al. Curr Opin Gastroenterol. 2019 Jul.

Abstract

Purpose of review: The current review provides an updated overview on the role of therapeutic drug monitoring (TDM) of biological therapies in inflammatory bowel disease (IBD). We examine the data behind TDM for the antitumor necrosis factor agents, vedolizumab and ustekinumab, in patients with IBD. In addition, we discuss reactive vs. proactive TDM.

Recent findings: There is a positive correlation between biologic drug concentrations and favorable therapeutic outcomes in IBD, although the majority of data refer to antitumor necrosis factor therapy. Reactive TDM has rationalized the management of patients with IBD with loss of response to biological therapy. Moreover, reactive TDM of infliximab has been proven to be more cost-effective when compared with empiric dose optimization. Preliminary data suggest that proactive TDM of infliximab and adalimumab applied in patients with clinical response/remission is associated with better therapeutic outcomes compared with standard of care (empiric treatment and/or reactive TDM).

Summary: For all biologics in IBD, there is a positive correlation between drug concentrations and favorable therapeutic outcomes. Reactive TDM is the new standard of care for optimizing biologic therapies in IBD, whereas recent data suggest an important role of proactive TDM for optimizing antitumor necrosis factor therapy in IBD.

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Figures

Figure 1.
Figure 1.. Reactive TDM algorithm of IBD patients on biological therapy.
*For relative values refer to Tables 1; **ATI >8 μg/mL-eq for ELISA and >10 U/ml for HMSA. ADA: anti-drug antibody; IMM: immunomodulators; ELISA: enzyme-linked immunosorbent assay; ATI: anti-infliximab antibodies; HMSA: homogeneous mobility shift assay; TDM: therapeutic drug monitoring; IBD: inflammatory bowel disease.
Figure 2.
Figure 2.. Proactive TDM algorithm of IBD patients on biological therapy.
*For relative values refer to Tables 1; **ATI >8 μg/mL-eq for ELISA and >10 U/ml for HMSA. ADA: anti-drug antibody; IMM: immunomodulators; ATI: anti-infliximab antibodies; ELISA: enzyme-linked immunosorbent assay; HMSA: homogeneous mobility shift assay; TDM: therapeutic drug monitoring; IBD: inflammatory bowel disease.
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References

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