Gordon Benjamin L, Battat Robert
Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY 10065, USA.
Center for Clinical and Translational Research in Inflammatory Bowel Diseases, Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada.
J Clin Med. 2023 May 10;12(10):3378. doi: 10.3390/jcm12103378.
Therapeutic drug monitoring (TDM) is a useful strategy in ulcerative colitis (UC). Nearly a quarter of UC patients will experience acute severe UC (ASUC) in their lifetime, including 30% who will fail first-line corticosteroid therapy. Steroid-refractory ASUC patients require salvage therapy with infliximab, cyclosporine, or colectomy. Fewer data are available for the use of TDM of infliximab in ASUC. The pharmacokinetics of ASUC make TDM in this population more complex. High inflammatory burden is associated with increased infliximab clearance, which is associated with lower infliximab drug concentrations. Observational data support the association between increased serum infliximab concentrations, lower clearance, and favorable clinical and endoscopic outcomes, as well as decreased rates of colectomy. Data regarding the benefit of accelerated or intensified dosing strategies of infliximab-as well as target drug concentration thresholds-in ASUC patients remain more equivocal, though limited by their observational nature. Studies are underway to further evaluate optimal dosing and TDM targets in this population. This review examines the evidence for TDM in patients with ASUC, with a focus on infliximab.
治疗药物监测（TDM）在溃疡性结肠炎（UC）中是一种有用的策略。近四分之一的UC患者在其一生中会经历急性重症UC（ASUC），其中30%的患者一线皮质类固醇治疗会失败。对类固醇难治的ASUC患者需要用英夫利昔单抗、环孢素或结肠切除术进行挽救治疗。关于在ASUC中使用英夫利昔单抗的TDM的数据较少。ASUC的药代动力学使该人群的TDM更加复杂。高炎症负担与英夫利昔单抗清除率增加有关，这与较低的英夫利昔单抗药物浓度有关。观察性数据支持血清英夫利昔单抗浓度增加、清除率降低与良好的临床和内镜结果以及结肠切除率降低之间的关联。关于ASUC患者中英夫利昔单抗加速或强化给药策略以及目标药物浓度阈值的益处的数据仍然更具争议性，尽管受其观察性质的限制。正在进行研究以进一步评估该人群的最佳给药和TDM目标。本综述探讨了ASUC患者中TDM的证据，重点是英夫利昔单抗。
