Therapeutic Drug Monitoring in Treatment of Inflammatory Bowel Disease with Infliximab

Yashar Jalali, Anna Krajcovicova, Tibor Hlavatý

Abstrakt


Abstract

Tumor necrosis factors α (TNF) antagonists are currently widely used in patients with moderate to severe Crohn's disease and ulcerative colitis. Approximately 50% of patients with inflammatory bowel disease (IBD) who initially benefit from treatment with TNF antagonists eventually lose response. However, the effect of the drug and its effectiveness is highly dependent on pharmacokinetics and pharmacodynamics. Therapeutic drug monitoring (TDM) is a new approach that measures drug levels and anti-drug antibodies (ADAb) to optimize treatment and achieve the best strategy in loss of response. Currently, there is no clear cut-off value that corresponds to the clinical response.ADAb production can cause a drop in levels or neutralize the drug, resulting in a loss of response. ADAbs may also contribute to infusion and injection reactions, thromboembolic events and serum sickness. This review article examines the evolution of TDM in the treatment of inflammatory bowel diseases. It examines the main contentions and developments surrounding the use of TDM in recent years, such as the level and loss of response, and describes current trends in TDM in clinical practice.

Abstract

TNF antagonists are currently commonly used in the treatment of moderate to severe forms of Crohn's disease and ulcerative colitis. Approximately 50% of patients with non-specific inflammatory bowel disease (IBD), who initially benefited from treatment with TNF antagonists, will eventually lose their healing effect. The efficacy of treatment is highly dependent on pharmacokinetics and pharmacodynamics. Drug Therapeutic Drug Monitoring (TDM), which is Drug and Drug Antibody Measurement (ADAb), is a new approach to optimizing treatment and achieving the lowest risk of loss of response. At present, an exact therapeutic level that would match the clinical response is unclear.ADAb production may lead to decreased levels of drug neutralization resulting in a loss of therapeutic effect. Additionally, ADAb may contribute to infusion reactions, thromboembolic events and serum sickness. This article examines the development of TDM in the treatment of IBD. He examines the main TDM claims as well as the evolution of their use in recent years, examines the therapeutic range, the loss of response, and describes current trends in clinical practice.


Klíčová slova


Inflammatory bowel disease, therapeutic drug monitoring, anti-drug antibodies, biologic treatment, trough level

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