- Title
- Review article: consensus statements on therapeutic drug monitoring of anti-tumour necrosis factor therapy in inflammatory bowel diseases
- Creator
- Mitrev, N.; Vande Casteele, N.; Corte, C.; Ghaly, S.; Lemberg, D. A.; Kariyawasam, V.; Lewindon, P.; Martin, J.; Mountifield, R.; Radford-Smith, G.; Slobodian, P.; Sparrow, M.; Seow, C. H.; Andrews, J. M.; Connor, S. J.; Moore, G. T.; Barclay, M.; Begun, J.; Bryant, R.; Chan, W.
- Relation
- Alimentary Pharmacology and Therapeutics Vol. 46, Issue 11-12, p. 137-143
- Publisher Link
- http://dx.doi.org/10.1111/apt.14368
- Publisher
- Wiley-Blackwell
- Resource Type
- journal article
- Date
- 2017
- Description
- Background: Therapeutic drug monitoring (TDM) in inflammatory bowel disease (IBD) patients receiving anti-tumour necrosis factor (TNF) agents can help optimise outcomes. Consensus statements based on current evidence will help the development of treatment guidelines. Aim: To develop evidence-based consensus statements for TDM-guided anti-TNF therapy in IBD. Methods: A committee of 25 Australian and international experts was assembled. The initial draft statements were produced following a systematic literature search. A modified Delphi technique was used with 3 iterations. Statements were modified according to anonymous voting and feedback at each iteration. Statements with 80% agreement without or with minor reservation were accepted. Results: 22/24 statements met criteria for consensus. For anti-TNF agents, TDM should be performed upon treatment failure, following successful induction, when contemplating a drug holiday and periodically in clinical remission only when results would change management. To achieve clinical remission in luminal IBD, infliximab and adalimumab trough concentrations in the range of 3-8 and 5-12 µg/mL, respectively, were deemed appropriate. The range may differ for different disease phenotypes or treatment endpoints-such as fistulising disease or to achieve mucosal healing. In treatment failure, TDM may identify mechanisms to guide subsequent decision-making. In stable clinical response, TDM-guided dosing may avoid future relapse. Data indicate drug-tolerant anti-drug antibody assays do not offer an advantage over drug-sensitive assays. Further data are required prior to recommending TDM for non-anti-TNF biological agents. Conclusion: Consensus statements support the role of TDM in optimising anti-TNF agents to treat IBD, especially in situations of treatment failure.
- Subject
- therapeutic drug monitoring; inflammatory bowel disease; anti-tumour necrosis factor agents; treatment guidelines
- Identifier
- http://hdl.handle.net/1959.13/1395569
- Identifier
- uon:33907
- Identifier
- ISSN:0269-2813
- Language
- eng
- Reviewed
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