Therapeutic drug monitoring of anti-TNF-α agents in inflammatory bowel diseases

Abstract

Introduction: The elaboration of effective and cost-saving algorithms for anti-TNF optimization in patients with inflammatory bowel diseases (IBD) represents one of the biggest challenges over the last few years. Recently, many studies have been focused on the identification of an optimal trough level (TL) for most used anti-TNF agents and on the role of anti-drug antibodies (ADAs), especially in the management of patients who lose response to biological treatments. Therapeutic drug monitoring may potentially help to also prevent lose of clinical benefit overtime and to reduce health-related costs.

Areas covered: Current evidence about the correlation between clinical outcomes and anti-TNF TLs, the role of ADAs in the context of safety and loss of response to anti-TNF, the utility of therapeutic drug monitoring in clinical practice.

Expert opinion: The data available so far support the utility of TL and ADA measurement for the management of IBD patients with loss of response to anti-TNF but does not currently authorizes a routine application in clinical practice of proactive therapeutic monitoring in patients in clinical remission. However, this remains a promising approach to optimize anti-TNF therapies and possibly to reduce health-related costs, then further prospective studies are strongly expected.

Keywords:

• anti-drug antibody
• anti-TNF
• inflammatory bowel disease
• therapeutic drug monitoring
• trough level

Declaration of interest

C Felice is a consultant and advisory board member for MSD. A Armuzzi is a consultant for AbbVie, Hospira, Lilly, MSD, Mundipharma, Pfizer, Sofar and Takeda, she has received lecture fees from AbbVie, AstraZeneca, Chiesi, Ferring, Hospira, MSD, Otsuka, Takeda and Zambon. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Notes

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