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Optimizing biologic therapy in IBD: how essential is therapeutic drug monitoring?

Abstract

Proposed treatment targets for the management of inflammatory bowel disease (IBD) have moved beyond symptomatic improvement towards more objective end points, such as healing of the intestinal mucosa. This treat-to-target approach has been associated with improved disease outcomes such as diminished bowel damage, surgery and hospitalizations. Many patients with IBD require biologic therapy to achieve and maintain clinical and endoscopic remission, and antitumour necrosis factor antibodies remain the first-line biologic therapy in most areas of the world. Unfortunately, up to one-third of patients receiving this treatment are primary non-responders, and some patients that show an initial response can also lose response over time. Therapeutic drug monitoring (TDM) has been suggested as a useful tool to manage patients on antitumour necrosis factor treatment, including monitoring for dose escalation, de-escalation or to switch treatment. In this Perspective, we aim to summarize evidence and guidelines related to TDM in IBD management and also discuss potential strategies to optimize biologic treatment where TDM is not available.

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Fig. 1: Concepts related to therapeutic drug monitoring in inflammatory bowel disease.
Fig. 2: Optimization of biologic therapy in areas of the world where therapeutic drug monitoring is unavailable.

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All authors contributed equally to this article.

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Correspondence to Geert D’Haens.

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G.H. has served as an adviser for Abbvie, Ablynx, Allergan, Alphabiomics, Amakem, Amgen, AM Pharma, Arena Pharmaceuticals, AstraZeneca, Avaxia, Biogen, Bristol Meyers Squibb, Boehringer Ingelheim, Celgene/Receptos, Celltrion, Cosmo, Echo Pharmaceuticals, Eli Lilly, Engene, Ferring, DrFALK Pharma, Galapagos, Genentech/Roche, Gilead, Glaxo Smith Kline, Gossamerbio, Hospira/Pfizer, Immunic, Johnson and Johnson, Kintai Therapeutics, Lycera, Medimetrics, Millenium/Takeda, Medtronics, Mitsubishi Pharma, Merck Sharp Dome, Mundipharma, Nextbiotics, Novonordisk, Otsuka, Pfizer/Hospira, Photopill, Prodigest, Prometheus laboratories/Nestle, Progenity, Protagonist, RedHill, Robarts Clinical Trials, Salix, Samsung Bioepis, Sandoz, Seres/Nestle, Setpoint, Shire, Teva, Tigenix, Tillotts, Topivert, Versant and Vifor, and has received speaker fees from Abbvie, Biogen, Ferring, Johnson and Johnson, Merck Sharp Dome, Mundipharma, Norgine, Pfizer, Samsung Bioepis, Shire, Millenium/Takeda, Tillotts and Vifor. M.A. has served as a speaker and consultant and is on advisory boards for Abbvie, Janssen, Takeda and Pfizer. P.G.K. has received speaking fees and consultancy for Abbvie, Janssen, Takeda, Pfizer and UCB. P.K. declares no competing interests.

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Argollo, M., Kotze, P.G., Kakkadasam, P. et al. Optimizing biologic therapy in IBD: how essential is therapeutic drug monitoring?. Nat Rev Gastroenterol Hepatol 17, 702–710 (2020). https://doi.org/10.1038/s41575-020-0352-2

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