News in Pediatric Gastroenterology Pharmacology
“Therapeutic drug monitoring (TDM)” to optimise anti-TNF treatment in inflammatory bowel disease. What are the experts’ recommendations today?
The Royal London Chidlren’s Hospital, Barts Health Trust Londra, United Kingdom
Anti-TNFα therapy has revolutionised treatment of inflammatory bowel disease (IBD). However, primary nonresponse (PNR) and secondary loss of response (LoR) remain a significant hurdle, currently affecting 13–46% of patients. Therapeutic drug monitoring (TDM) has recently emerged as a means of optimising use of anti-TNFα agents. TDM refers to the practice of measuring anti-TNF trough level drug concentration and anti-drug antibody in patients on anti-TNF therapy with active disease, to guide clinical decision making and prevent LoR. Whilst the existing limited evidence does not yet support an association between TDM and superior clinical remission rates, it describes a cost savings benefit and suggests a potential benefit for anti-TNF durability. Experts worldwide are endorsing TDM and recommend larger prospective trials to confirm its added value in guiding the management of patients with IBD on anti-TNF.