Biologic concentration testing in inflammatory bowel disease

Byron P. Vaughn, William J. Sandborn, Adam S. Cheifetz

Research output: Contribution to journalReview articlepeer-review

49 Scopus citations

Abstract

Anti-TNF medications have revolutionized the care of patients with inflammatory bowel disease. However, despite an initial robust effect, loss of response is common and long-term results are disappointing. Much of this lack of durability may be due to inadequate dose optimization, and recent studies suggest a correlation between serum drug concentrations and clinical outcomes. Currently, in clinical practice, measurement of drug concentrations and antibodies to drug are typically performed only when a patient presents with active inflammatory bowel disease symptoms or during a potential immune-mediated reaction to anti-TNF ("reactive" setting). However, proactive monitoring of anti-TNF concentrations with titration to a therapeutic window (i.e., therapeutic concentration monitoring) represents a new strategy with many potential clinical benefits including prevention of immunogenicity, less need for IFX rescue therapy, and greater durability of IFX treatment. This review will cover the salient features of anti-TNF pharmacokinetics and pharmacodynamics and provide a rational approach for the use of anti-TNF concentration testing in both the reactive and proactive settings.

Original languageEnglish (US)
Pages (from-to)1435-1442
Number of pages8
JournalInflammatory bowel diseases
Volume21
Issue number6
DOIs
StatePublished - Apr 3 2015

Keywords

  • Anti-TNF
  • Crohn's disease
  • adalimumab
  • inflammatory bowel disease
  • infliximab
  • loss of response
  • pharmacodynamics
  • pharmacokinetics
  • therapeutic concentration monitoring
  • ulcerative colitis

Fingerprint

Dive into the research topics of 'Biologic concentration testing in inflammatory bowel disease'. Together they form a unique fingerprint.

Cite this