Tumor necrosis factor-antagonists have an established role in the treatment of inflammatory bowel diseases (IBD).
However, subtherapeutic drug levels and the formation of anti-drug antibodies may decrease their efficacy.
The evidence supporting the use of therapeutic drug monitoring based clinical algorithms for infliximab, and their role in clinical practice will be discussed.
Dr Khanna and colleagues from Canada reviewed the literature to identify relevant articles on the measurement of infliximab levels and antibodies-to-infliximab.
|Treatment algorithms have evolved to long-term combination therapy|
|Alimentary Pharmacology & Therapeutics|
Treatment algorithms for inflammatory bowel diseases have evolved from episodic monotherapy used in patients refractory to all other treatments, to long-term combination therapy initiated early in the disease course.
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.
The team noted that 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 concluded, "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."