Therapeutic drug monitoring of anti‐tumour necrosis factor‐α agents in inflammatory bowel disease: Limits and improvements

Abstract

Since the publication of the American Gastroenterological Association's recommendations in 2017, there have been no significant changes in the biological monitoring recommendations in inflammatory bowel disease. Possible limitations are the lack of evidence to recommend proactive therapeutic drug monitoring (pTDM) over reactive TDM (rTDM), and the limited information about individualized dosing methods. This article aims to review the TDM strategy updates and the use of individualized dosing methods. Methods: For the analysis of the TDM strategies and individualized dosing method, a search was carried out in PubMed and Cochrane Central. In the TDM case, since August 2017.Results: A total of 263 publications were found, but only 7 related to proactive TDM.Five of these publications directly compared pTDM vs rTDM and 2 were randomized clinical trials. Six studies found benefits of pTDM and 1 found no differences.Regarding the individualized dosing method, 229 distinct results were found.Population pharmacokinetics was the most widely used method to develop individual dosage models and to analyse the influence of factors on drug concentrations (albumin concentration, weight, presence of anti-drug antibodies etc). Conclusion:We have found no major changes in TDM strategies. There is a growing trend towards the use of pTDM because it has shown a longer duration of treatment response, lower rates of discontinuation and relapses. However, the available evidence is limited and of low quality. Despite the common use of population pharmacokinetic methods to analyse pharmacokinetic factors, they are not commonly used for personalized dosing.

Enhancing Therapeutic Drug Monitoring in Inflammatory Bowel Disease: A Comparative Analysis of Rapid Point-of-Care Infliximab, Adalimumab and Anti-Drug Antibodies’ Determination against ELISA

“…It neutralizes its biological function by blocking its interaction with p55 and p75 receptors on the cell surface and attenuating its proinflammatory effects. Their introduction as the first line of biological therapy was a great advantage for IBD patients because they were shown to induce and maintain both clinical remission and mucosal healing when conventional therapies became unresponsive, and they significantly improved patients' quality of life [5,6].…”

“…Therapeutic drug monitoring (TDM), defined as the assessment of drug concentrations and the detection of ADAs, is an important tool for optimizing biologic therapy [6]. In a reactive strategy, TDM can be used to identify the cause for the secondary loss of response.…”