2018
DOI: 10.1093/ibd/izy044
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Therapeutic Drug Monitoring Guides the Management of Crohn’s Patients with Secondary Loss of Response to Adalimumab

Abstract: Our data do not support empiric dose adjustment beyond that based on the result of the TDM in patients with LOR to ADA. TDM limits unnecessary dose escalation and provides appropriate treatment strategy without compromising clinical outcomes. 10.1093/ibd/izy044_video1izy044.video15768828880001.

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Cited by 37 publications
(46 citation statements)
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“…Reactive TDM has rationalized the management of PNR and SLR and has proven more cost-effective when compared with empiric dose escalation. [96][97][98][99][100][101][102] Preliminary data suggest that proactive TDM, with drug titration to a target trough concentration, performed in patients with clinical response/remission can also improve the efficacy of anti-TNFs. 38,39,103,104 Moreover, proactive TDM may also improve the cost-effectiveness and safety of biologic therapy via the implementation of a de-escalation strategy in patients with supratherapeutic drug concentrations by reducing the dose, increasing the time interval, and/or stopping the immunomodulator in patients on combination therapy (optimized monotherapy).…”
mentioning
confidence: 99%
“…Reactive TDM has rationalized the management of PNR and SLR and has proven more cost-effective when compared with empiric dose escalation. [96][97][98][99][100][101][102] Preliminary data suggest that proactive TDM, with drug titration to a target trough concentration, performed in patients with clinical response/remission can also improve the efficacy of anti-TNFs. 38,39,103,104 Moreover, proactive TDM may also improve the cost-effectiveness and safety of biologic therapy via the implementation of a de-escalation strategy in patients with supratherapeutic drug concentrations by reducing the dose, increasing the time interval, and/or stopping the immunomodulator in patients on combination therapy (optimized monotherapy).…”
mentioning
confidence: 99%
“…A recent retrospective cohort study emphasized the importance of measuring adalimumab serum levels early, which may guide dose optimization and prevent immunogenicity with associated treatment failure 17 . Other studies showed that TDM limits unnecessary dose escalation and provides appropriate treatment strategy without compromising clinical outcomes 18 . Researches have been made using LISA-TRACKER immunoassays for different anti-TNFα as In iximab, Adalimumab, Etanercept 19 , Certolizumab and Golimumab 20 , but a few presented results about biosimilars.…”
Section: Discussionmentioning
confidence: 99%
“…In addition to aiming for objective targets, the follow-up should include subjective patient-reported outcomes, objective laboratory (CRP and FC) and/or cross-section imaging (MRE and CTE), and/or upper and lower GI endoscopic data, assessment of dietary and nutritional needs, and evaluation of other medical/psychiatric comorbidities to obtain a complete picture of each patient’s health and well-being. Moreover, patients on biologic and immunosuppressant therapy may benefit from therapeutic drug monitoring to aid in drug optimization and prevent toxicity by measuring trough levels and assessing for the development of anti-drug antibodies [ 110 , 111 , 112 , 113 , 114 ].…”
Section: A Proactive Algorithmic Approachmentioning
confidence: 99%