Therapeutic drug monitoring of biologics in inflammatory bowel disease: unmet needs and future perspectives

TLDR

Therapeutic drug monitoring has emerged as a useful tool for optimizing biologics, and in particular anti-tumor necrosis factor (anti-TNF) therapy, in both inflammatory bowel disease and other immune-mediated inflammatory diseases such as rheumatoid arthritis and psoriasis, however, there are still some challenges hindering the widespread implementation of TDM in clinical practice.

Abstract

Summary Therapeutic drug monitoring (TDM) has emerged as a useful tool for optimizing biologics, and in particular anti-tumor necrosis factor (anti-TNF) therapy, in both inflammatory bowel disease (IBD) and other immune-mediated inflammatory diseases such as rheumatoid arthritis and psoriasis. However, there are still some challenges hindering the widespread implementation of TDM in clinical practice. These barriers include identification of the optimal drug concentration to target, the lag time between sampling and results, and the proper interpretation of anti-drug antibody titers among different assays. Solutions to overcome these barriers include the harmonization of TDM assays and the use of point-of-care testing. Other unmet needs include well-designed prospective studies and randomized controlled trials focusing on proactive TDM particularly during induction therapy. Future studies should also investigate the utility of TDM in biologics other than anti-TNFs in both IBD and other immune-mediated inflammatory diseases and the use of pharmacokinetic dashboards and pharmacogenetics towards individual personalized medicine.