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Therapeutic drug monitoring in inflammatory bowel disease

for every patient and every drug?

Papamichael, Konstantinos; Cheifetz, Adam S.

Current Opinion in Gastroenterology: July 2019 - Volume 35 - Issue 4 - p 302–310
doi: 10.1097/MOG.0000000000000536
INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro
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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.

Division of Gastroenterology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Adam S. Cheifetz, MD, Director, Division of Gastroenterology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Rabb 425, Boston, MA 02215, USA; Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA. Tel: +1 617 667 2802; fax: +1 617 667 5826; e-mail: acheifet@bidmc.harvard.edu

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