Mark A Samaan1, Zehra Arkir2, Tariq Ahmad3, Peter M Irving1. 1. a Guy's & St. Thomas' NHS Foundation Trust , IBD Centre , London , UK. 2. b Viapath, Reference Chemistry Laboratory, St Thomas' Hospital , London , UK. 3. c Royal Devon & Exeter NHS Foundation Trust , IBD and Pharmacogenetics Research Group , Exeter , UK.
Abstract
BACKGROUND: We aimed to understand the way in which therapeutic drug monitoring (TDM) is used, understood and interpreted for anti-TNF agents in IBD. RESEARCH DESIGN AND METHODS: We designed an 18-question survey that included 5 TDM-based clinical scenarios, for which the 'most appropriate' responses were based on the BRIDGe groups 'Anti-TNF Optimizer'. This resource combines TDM evidence with expert consensus. RESULTS: We received 110 complete responses: 50 (45%) consultants, 30 (27%) trainees, 25 (23%) IBD nurse specialists and 5 (5%) gastroenterology pharmacists. Over half (61, 55%) only carry out TDM in non-response. The remainder use TDM routinely, including during stable maintenance therapy for patients in remission. Lower therapeutic thresholds used were variable. Most (82, 75%) were unsure whether their laboratory uses a drug-tolerant or drug-sensitive antidrug antibody assay and few (15, 14%) understand the difference. Consultants, high-frequency users (> 3requests/month) and clinicians with larger anti-TNF cohorts (> 100) were significantly more likely to select the 'most appropriate' answer to at least 1 of the 5 TDM-based clinical scenarios. CONCLUSIONS: There exists marked heterogeneity in the practical use, understanding and interpretation of biologic TDM. Biologic decision-making, informed by TDM, should involve consultation with experienced clinicians who are frequent TDM users, ideally, as part of a multidisciplinary, biologics-focused IBD meeting. ABBREVIATIONS: TDM: therapeutic drug monitoring; CNS: clinical nurse specialist; ELISA: enzyme-linked immunosorbent assay; RIA: radioimmunoassays; HMSA: homogenous mobility shift assays; BSG: British Society of Gastroenterology.
BACKGROUND: We aimed to understand the way in which therapeutic drug monitoring (TDM) is used, understood and interpreted for anti-TNF agents in IBD. RESEARCH DESIGN AND METHODS: We designed an 18-question survey that included 5 TDM-based clinical scenarios, for which the 'most appropriate' responses were based on the BRIDGe groups 'Anti-TNF Optimizer'. This resource combines TDM evidence with expert consensus. RESULTS: We received 110 complete responses: 50 (45%) consultants, 30 (27%) trainees, 25 (23%) IBD nurse specialists and 5 (5%) gastroenterology pharmacists. Over half (61, 55%) only carry out TDM in non-response. The remainder use TDM routinely, including during stable maintenance therapy for patients in remission. Lower therapeutic thresholds used were variable. Most (82, 75%) were unsure whether their laboratory uses a drug-tolerant or drug-sensitive antidrug antibody assay and few (15, 14%) understand the difference. Consultants, high-frequency users (> 3requests/month) and clinicians with larger anti-TNF cohorts (> 100) were significantly more likely to select the 'most appropriate' answer to at least 1 of the 5 TDM-based clinical scenarios. CONCLUSIONS: There exists marked heterogeneity in the practical use, understanding and interpretation of biologic TDM. Biologic decision-making, informed by TDM, should involve consultation with experienced clinicians who are frequent TDM users, ideally, as part of a multidisciplinary, biologics-focused IBD meeting. ABBREVIATIONS: TDM: therapeutic drug monitoring; CNS: clinical nurse specialist; ELISA: enzyme-linked immunosorbent assay; RIA: radioimmunoassays; HMSA: homogenous mobility shift assays; BSG: British Society of Gastroenterology.
Entities:
Keywords:
Biologics; adalimumab; anti-TNF; infliximab; therapeutic drug monitoring
Authors: José Germán Sánchez-Hernández; Noemí Rebollo; Ana Martin-Suarez; M Victoria Calvo; Fernando Muñoz Journal: Br J Clin Pharmacol Date: 2020-02-21 Impact factor: 4.335
Authors: Rebecca Sagar; Marco V Lenti; Tanya Clark; Helen J Rafferty; David J Gracie; Alexander C Ford; Anthony O'Connor; Tariq Ahmad; P John Hamlin; Christian P Selinger Journal: Inflamm Intest Dis Date: 2021-04-13
Authors: Reinier Cornelis Anthonius van Linschoten; Nikki van Leeuwen; Daan Nieboer; Erwin Birnie; Menne Scherpenzeel; Karen Evelyne Verweij; Vincent de Jonge; Jan Antonius Hazelzet; C Janneke van der Woude; Rachel Louise West; Desirée van Noord Journal: BMJ Open Date: 2022-01-12 Impact factor: 2.692