Key insights from therapeutic drug monitoring in Crohn’s disease patients

ABSTRACT

Introduction: The incidence and prevalence of Crohn’s disease are increasing causing a significant disease burden. Therapeutic drug monitoring (TDM) is advocated as a promising tool for personalized or individual-tailored therapy strategies and has been welcomed as a new means to improve current therapy strategies. Nevertheless, pharmacokinetic-based TDM has limitations, and straightforward target concentrations for most therapies are lacking.

Areas covered: In the following concise review of literature, key insights of TDM in thiopurine, methotrexate, anti-TNF, vedolizumab and ustekinumab therapy for Crohn’s disease are being described.

Expert opinion: Therapeutic drug monitoring may, up till now, be helpful to adjust thiopurine and infliximab therapy, primarily in a reactive setting, in case of inefficacy and of occurrence of adverse event. With this restricted application, the goal of individualized therapy based on TDM has not yet been achieved.

KEYWORDS:

• Crohn’s disease
• therapeutic drug monitoring
• thiopurine
• methotrexate
• anti-TNF
• TPMT
• vedolizumab
• ustekinumab

Article highlights

• Reactive therapeutic drug monitoring (TDM) for thiopurine, infliximab and adalimumab therapy is recommended by international guidelines.

• Yet there is not enough data available to support proactive TDM in thiopurine, infliximab and adalimumab therapy.

• Data regarding TDM in methotrexate, ustekinumab and vedolizumab are scarce.

• A pharmacodynamic parameter may potentially be a more informative biomarker, relating drug with intended effect and, thus, providing crucial insight in (i.e. predicting) therapeutic success.

This box summarizes key points contained in the article.

Declaration of interest

AA van Bodegraven received lecture/consulting fees from AbbVie, Arandal, Ferring, Janssen, MSD, Pfizer, RIVM, Takeda, TEVA, Tramedico, KNMG, KNMP, and NVFG; has performed contract research for AbbVie, Celgene, MSD, Receptos, Roche, Pfizer, Takeda, and TEVA; has received educational/research grants from Ferring, Janssen, TEVA, and ZonMW. NKH de Boer has received consulting fees from TEVA and Merck, lecture fees from AbbVie, Tillots, and Takeda; has received research grants (unrestricted) from Takeda, Falk, and Ferring; and a travel grant from Takeda. 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This article was not funded.