Proactive Infliximab Drug Monitoring Is Superior to Conventional Management in Inflammatory Bowel Disease

Abstract

In patients with inflammatory bowel disease, proactive therapeutic drug monitoring of infliximab over a 2-year period was associated with higher rates of mucosal healing and lower surgical requirements compared with a conventional cohort treated without therapeutic drug monitoring.

Efficacy of dashboard driven dosing of infliximab in inflammatory bowel disease patients; a randomized controlled trial

“…Indeed, since treatment goals often differ between IBD patients and might also change during the disease course, personalized treatment is highly relevant. The results of this study are in line with recently published retrospective analyses showing improved outcomes in IBD patients receiving proactive monitoring of anti-TNF serum concentrations compared to a reactive TDM-based approach [32][33][34][35]. Factors that are helpful for treatment personalization are those influencing the clearance of therapeutic antibodies in IBD patients.…”

Correlation of serum levels of anti-tumor necrosis factor agents with perianal fistula healing in Crohn’s disease: a narrative review

“…[35][36][37] However, other studies suggest that the use of proactive TDM may be associated with higher clinical, biological and endoscopic response rates, longer persistence of therapy, less complications such as hospitalizations, surgery or infusion reactions due to immunogenicity. [38][39][40] Proactive TDM either may be more cost-effective in simulation studies. 41 Although there are different methods of measuring drug levels and antidrug concentrations, none may be considered as a gold standard.…”

Is It Prime Time for Proactive Therapeutic Drug Monitoring of Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Disease?

“…Furthermore, there is an increasing body of literature to support the benefit of proactive over empiric dose escalation and/or reactive TDM, although most of these studies are retrospective (Table 1). [5][6][7][8][9][10][11][12][13] In the current issue of Gastroenterology, Assa et al 12 provide increasing supportive evidence for the usefulness of proactive TDM over standard dosing and reactive TDM in their randomized controlled trial (RCT) called Paediatric Crohn's disease Adalimumab-Level-based Optimisation Treatment (PAILOT). This well-designed pragmatic study prospectively assessed whether proactive TDM was superior to reactive testing in pediatric Crohn's disease (CD).…”

“…19 A very recent observational study did demonstrate that proactive TDM compared with conventional non-TDM-based management was independently associated with fewer surgeries (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.13-0.95; P ¼ .039) and higher rates of mucosal healing (OR, 3.26; 95% CI, 1.68-6.31; P < .001). 9 Although the PAILOT study was limited by a small sample size, a nonblinded design, and a low targeted adalimumab concentration, it was a huge step forward in the field of TDM and adds significant credence to the growing body of literature demonstrating the importance of proactive TDM.…”