Therapeutic Drug Monitoring · 3 authors, 4 centres
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This narrative review discusses the role of proactive therapeutic drug monitoring (TDM) of anti-TNF biological agents in patients with inflammatory bowel disease (IBD) and other immune-mediated inflammatory diseases (IMID). Growing evidence suggests proactive TDM is associated with better outcomes than empiric optimization and/or reactive TDM in IBD.
The authors examine proactive TDM of biological agents, particularly anti-TNF therapies such as infliximab and adalimumab, in patients with IBD and other IMID. Proactive TDM aims to achieve adequate drug concentrations so patients attain and maintain optimal treatment response. Key applications include de-escalation of anti-TNF therapy in clinical remission and optimizing infliximab monotherapy as an alternative to combination immunomodulator therapy. In pediatric IBD patients, early TDM during induction therapy with dose modifications guided by measurement timing may facilitate mucosal healing. The review identifies knowledge gaps, noting that target drug concentration thresholds for biological agents and the role of proactive TDM for non-anti-TNF biologicals still need to be established. Future directions include pharmacogenetics, PK modeling, and dashboards to guide dosing decisions.
