Christopher Sheasgreen1, Geoffrey C Nguyen2. 1. Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Joseph and Wolf Lebovic Health Complex, 437-600 University Avenue, Toronto, ON, M5G 1X5, Canada. 2. Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Joseph and Wolf Lebovic Health Complex, 437-600 University Avenue, Toronto, ON, M5G 1X5, Canada. geoff.nguyen@utoronto.ca.
Abstract
PURPOSE OF REVIEW: Biological medications are effective in inflammatory bowel disease (IBD) but adverse events, cost, and loss of response make their use challenging. Therapeutic drug monitoring (TDM) allows clinicians to more safely, effectively, and efficiently use medications. The purpose of this article is to review and summarize the most recent literature pertaining to TDM in IBD. RECENT FINDINGS: Measurement of biological drug trough levels predicts ongoing patient response and can be used to titrate the medication to be more effective and efficient. Antibodies against the medications predict loss of response and adverse events. Using both parameters can predict response to subsequent biologicals. Newer biologicals show similar characteristics to those more commonly used. Management protocols using drug and antibody levels optimize medication use and may be cost-effective. Recent evidence suggests benefit to TDM of biologicals in IBD.
PURPOSE OF REVIEW: Biological medications are effective in inflammatory bowel disease (IBD) but adverse events, cost, and loss of response make their use challenging. Therapeutic drug monitoring (TDM) allows clinicians to more safely, effectively, and efficiently use medications. The purpose of this article is to review and summarize the most recent literature pertaining to TDM in IBD. RECENT FINDINGS: Measurement of biological drug trough levels predicts ongoing patient response and can be used to titrate the medication to be more effective and efficient. Antibodies against the medications predict loss of response and adverse events. Using both parameters can predict response to subsequent biologicals. Newer biologicals show similar characteristics to those more commonly used. Management protocols using drug and antibody levels optimize medication use and may be cost-effective. Recent evidence suggests benefit to TDM of biologicals in IBD.
Entities:
Keywords:
Antibodies to drug; Biologic therapy; Crohn’s disease; Inflammatory bowel disease; Therapeutic drug monitoring; Trough level; Ulcerative colitis
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