How, When, and For Whom Should We Perform Therapeutic Drug Monitoring?

Severine Vermeire, Erwin Dreesen, Konstantinos Papamichael, Marla C Dubinsky
Clinical Gastroenterology and Hepatology 2019 October 4
The implementation of therapeutic drug monitoring (TDM) in the inflammatory bowel disease (IBD) practice has evolved during the years. In the early days, the focus was merely on the measuring and reporting of drug concentrations. Later, these concentrations were considered in light of target concentrations that are related to clinical response. This did not only allow passively predicting a patient's future response, but it also triggered physicians and pharmacists to actively use the information to optimize the drug dosage to induce and maintain clinical response in the future. While reactive TDM, testing at time of loss of response, is widely accepted in practice especially for the anti-TNF antibodies, there is less data for the other monoclonal antibodies belonging to other classes. Besides reactive testing, there is a movement towards proactively adjusting biologic dosing to prevent loss of response in keeping with the tight control philosophy of IBD care. This review highlights the various assays available to measure drug concentrations and anti-drug antibodies as well as algorithmic approaches to TDM, the unmet needs and required studies to enable pharmacokinetics principles to be applied in the future.


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