Department of Medicine, University of Otago, Dunedin, New Zealand.
Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand.
Intern Med J. 2021 Mar;51(3):341-347. doi: 10.1111/imj.14778.
Routine therapeutic drug monitoring (TDM) during treatment with anti-tumour necrosis factor (anti-TNF) agents in inflammatory bowel disease may increase treatment efficacy and cost-effectiveness, and reduce the risk of loss of response.
To assess the current use of anti-TNF agent TDM, including trough concentration and anti-drug antibodies, among gastroenterology practitioners in New Zealand.
A web-based survey was delivered to gastroenterologists and advanced trainees in New Zealand, identified by the New Zealand Society of Gastroenterology.
The response rate was 36% (48/134). Adalimumab was the most common initial anti-TNF agent used (78%, infliximab 22%). Ninety-three percent of those who completed the survey used TDM, mainly in cases of non-response or loss or response. Most respondents (93% and 83% for adalimumab and infliximab, respectively) measured trough concentrations within 24 h prior to the next administration. In patients in clinical remission but with endoscopic inflammation on anti-TNF agents, 72% would measure drug concentrations. In the presence of anti-drug antibodies, 45% would add an immunomodulator in patients with active disease and 47% would add an immunomodulator in patients in remission. With low trough concentrations, 77% would make no changes if the patient was in remission, and 75% would increase the dose in case of active disease.
TDM was routinely used among inflammatory bowel disease gastroenterology clinicians who responded to this survey. However, interpretation of results and decision-making is variable, suggesting more guidance is required.
在炎症性肠病患者使用抗肿瘤坏死因子（anti-TNF）药物治疗过程中，常规进行治疗药物监测（TDM）可能会提高治疗效果和成本效益，并降低应答丧失的风险。
评估新西兰胃肠病医生目前对 anti-TNF 药物 TDM（包括谷浓度和抗药物抗体）的使用情况。
通过新西兰胃肠病学会鉴定，向新西兰胃肠病医生和高级培训医生发送了一份网络调查。
应答率为 36%（48/134）。阿达木单抗是最常用的初始 anti-TNF 药物（78%，英夫利昔单抗 22%）。完成调查的 93%的人使用 TDM，主要用于无应答或应答丧失的情况。大多数应答者（阿达木单抗和英夫利昔单抗分别为 93%和 83%）在下次给药前 24 小时内测量谷浓度。在接受抗 TNF 药物治疗但内镜下仍有炎症的患者中，72%的人会测量药物浓度。存在抗药物抗体时，45%的人会在有疾病活动的患者中添加免疫调节剂，47%的人会在缓解期患者中添加免疫调节剂。如果患者处于缓解期，而谷浓度较低，77%的人不会进行任何更改，75%的人会在有疾病活动时增加剂量。
接受这项调查的炎症性肠病胃肠病临床医生常规使用 TDM。然而，结果的解释和决策存在差异，这表明需要更多的指导。
