Title :

Therapeutic Drug Monitoring (TDM) in IBD

Category :

Anti-TNFs, Biologics, Therapeutic drug monitoring

Drug :

Anti-TNF therapy
  • 43 year old with Crohn’s disease on adalimumab/Humira but now has developed a loss of response.
  • Low trough level and elevated antibody: what is next?
    • Who checks levels and when do you check levels? We need to understand that ‘one size doesn’t fit all’ and therefore TDM should be routinely practiced.
    • Which assay do you typically use? This depends on your institution, patient’s insurance and costs.
    • How do you interpret the drug and antibody levels?
    • Low drug level, low/undetectable antibodies -> dose escalate anti TNF
    • Normal drug level, detectable antibodies -> maximize anti-TNF efficacy, consider IMM; consider switch to another anti-TNF or out of class biologic
    • Normal drug level, low/undetectable antibodies -> evaluate for active disease, scope, imaging
    • When do you consider combination therapy with an immunomodulator and biologic agent? Based on clinical symptoms, severity of symptoms, age, predictors of severe disease, response to treatment
    • Who has used the newer assays – vedolizumab, certolizumab? Newer assays are now available

Consensus: TDM is an important clinical practice for IBD management of response to treatment and consideration of change in treatment. One dose isn’t for all.

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