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Supervisors sometimes have to manage both the micro-and macro-prudential dimensions of bank stability. These may either conflict or complement each other. We analyze prudential supervision by the Central Bank of Russia (CBR). We find evidence of micro-prudential concerns, measured as the rule-based enforcement of bank standards. Macro-prudential concerns are also documented: Banks in concentrated bank markets, large banks, money center banks and large deposit banks are less likely to face license withdrawal. Further, the CBR is reluctant to withdraw licenses when there are "too many banks to fail". Finally, macro-prudential concerns induce regulatory forbearance, revealing conflicts with micro-prudential objectives.

Background With point of care testing (POCT) for infliximab (IFX), ultraproactive therapeutic drug monitoring (TDM) with ad-hoc dose optimisation is possible in patients with inflammatory bowel disease (IBD). Aim To compare the clinical outcomes of an ultraproactive TDM algorithm of IFX based on POCT with reactive TDM in patients with IBD, in a pragmatic clinical trial. Methods All patients with IBD and maintenance IFX treatment were included between June and August 2018 in two centers. Center A applied an ultra-proactive TDM algorithm incorporating POCT, while center B applied reactive TDM. Primary endpoint was failure of IFX therapy after one year. Secondary endpoints included sustained clinical remission and mucosal remission. Results In total 187 patients (n=115/72 cohort A/B) were included. Cohort A had more TL measurements compared with cohort B (8.8 vs 1/patient/year; p<.0001), leading to a significant higher number of dose optimizations. POCT testing was required in 27% after the first round of ultraproactive TDM and in a mean of 6.3% (SD 1.9) in the subsequent rounds. Ad-hoc extra dosing was needed in 13% of the POCT. After one year, no difference was seen between cohort A and cohort B in IFX failure (19% vs 10%; p=.08), nor in sustained clinical remission (75% vs 83%; p=.17). Mucosal remission was evaluated in 71 patients (38%), and was more frequent in the reactive TDM cohort (p=.02). Conclusion Ultraproactive TDM in patients with IBD and maintenance IFX treatment leads to equal clinical outcomes as reactive TDM after one year of follow-up.

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