Tumour necrosis factor-antagonists have an established role in the treatment of inflammatory bowel diseases, however, subtherapeutic drug levels and the formation of anti-drug antibodies may decrease their efficacy.
Dr Khanna and colleagues from the United Kingdom analyzed the evidence supporting the use of therapeutic drug monitoring based clinical algorithms for infliximab, and discussed their role in clinical practice.
The literature was reviewed to identify relevant articles on the measurement of infliximab levels and antibodies-to-infliximab.
Treatment algorithms for inflammatory bowel disease have evolved from episodic monotherapy used in patients refractory to all other treatments, to long-term combination therapy initiated early in the disease course.
|Multiple therapeutic drug monitoring-based algorithms have been developed |
|Alimentary Pharmacology & Therapeutics|
The researchers observed improved remission rates with this paradigm shift, nevertheless many patients ultimately lose response to therapy.
Although empiric dose optimization or switching agents constitute the current standard of care for secondary failure, these interventions have not been applied in an evidence-based manner, and are probably not cost-effective.
Multiple therapeutic drug monitoring-based algorithms have been developed to identify patients that may benefit from measurement of infliximab and anti-drug antibodies levels to guide adjustments to therapy.
Dr Khanna's team concludes, "Therapeutic drug monitoring offers a rational approach to the management of secondary failure to infliximab."
"This concept has gained momentum based on evidence from case series, cohort studies and post-hoc analyses of randomised controlled trials."