Division of Gastroenterology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Gastroenterol. 2019 Jul;35(4):302-310. doi: 10.1097/MOG.0000000000000536.
The current review provides an updated overview on the role of therapeutic drug monitoring (TDM) of biological therapies in inflammatory bowel disease (IBD). We examine the data behind TDM for the antitumor necrosis factor agents, vedolizumab and ustekinumab, in patients with IBD. In addition, we discuss reactive vs. proactive TDM.
There is a positive correlation between biologic drug concentrations and favorable therapeutic outcomes in IBD, although the majority of data refer to antitumor necrosis factor therapy. Reactive TDM has rationalized the management of patients with IBD with loss of response to biological therapy. Moreover, reactive TDM of infliximab has been proven to be more cost-effective when compared with empiric dose optimization. Preliminary data suggest that proactive TDM of infliximab and adalimumab applied in patients with clinical response/remission is associated with better therapeutic outcomes compared with standard of care (empiric treatment and/or reactive TDM).
For all biologics in IBD, there is a positive correlation between drug concentrations and favorable therapeutic outcomes. Reactive TDM is the new standard of care for optimizing biologic therapies in IBD, whereas recent data suggest an important role of proactive TDM for optimizing antitumor necrosis factor therapy in IBD.
本综述提供了生物治疗药物监测（TDM）在炎症性肠病（IBD）中作用的最新概述。我们检查了 IBD 患者抗肿瘤坏死因子药物（英夫利昔单抗、阿达木单抗、维得利珠单抗和乌司奴单抗）TDM 的相关数据。此外，我们还讨论了反应性和主动 TDM。
生物药物浓度与 IBD 的良好治疗效果之间存在正相关，尽管大多数数据均与抗肿瘤坏死因子治疗相关。反应性 TDM 优化了对生物治疗反应不佳的 IBD 患者的管理。此外，与经验性剂量优化相比，英夫利昔单抗的反应性 TDM 被证明更具成本效益。初步数据表明，与标准治疗（经验性治疗和/或反应性 TDM）相比，在有临床缓解/缓解的患者中主动 TDM 应用于英夫利昔单抗和阿达木单抗与更好的治疗效果相关。
对于 IBD 中的所有生物制剂，药物浓度与良好的治疗效果之间存在正相关。反应性 TDM 是优化 IBD 中生物治疗的新标准，而最近的数据表明，主动 TDM 在优化 IBD 中抗肿瘤坏死因子治疗方面具有重要作用。
