Therapeutic drug monitoring of biologics in inflammatory bowel disease: unmet needs and future perspectives
Konstantinos Papamichael
(1)
,
Waqqas Afif
(2)
,
David Drobne
(3)
,
Marla Dubinsky
(4)
,
Marc Ferrante
(5)
,
Peter Irving
(6)
,
Nikolaos Kamperidis
(7)
,
Taku Kobayashi
(8)
,
Paulo Kotze
(9)
,
Jo Lambert
(10)
,
Nurulamin Noor
(11)
,
Xavier Roblin
(12)
,
Giulia Roda
(13)
,
Niels Vande Casteele
(14)
,
Andres Yarur
(15)
,
Naila Arebi
(7)
,
Silvio Danese
(13)
,
Stephane Paul
(12)
,
William Sandborn
(14)
,
Séverine Vermeire
(5)
,
Adam Cheifetz
(1)
,
Laurent Peyrin-Biroulet
(16, 17)
1
BIDMC -
Beth Israel Deaconess Medical Center [Boston]
2 MUHC - McGill University Health Center [Montreal]
3 University of Ljubljana
4 MSSM - Icahn School of Medicine at Mount Sinai [New York]
5 University Hospitals Leuven [Leuven]
6 Guy's and St Thomas' Hospital [London]
7 Imperial College London
8 Kitasato University
9 PUCPR - Pontifícia Universidade Católica do Paraná [Curitiba, Brasil] = Pontifical Catholic University of Paraná [Curitiba, Brazil] = Université catholique pontificale du Paraná [Curitiba, Brésil]
10 Ghent University Hospital
11 CUH - Cambridge University Hospitals - NHS
12 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
13 Hunimed - Humanitas University [Milan]
14 UC San Diego - University of California [San Diego]
15 MCW - Medical College of Wisconsin [Milwaukee]
16 Service d'Hépato-gastro-entérologie [CHRU Nancy]
17 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
2 MUHC - McGill University Health Center [Montreal]
3 University of Ljubljana
4 MSSM - Icahn School of Medicine at Mount Sinai [New York]
5 University Hospitals Leuven [Leuven]
6 Guy's and St Thomas' Hospital [London]
7 Imperial College London
8 Kitasato University
9 PUCPR - Pontifícia Universidade Católica do Paraná [Curitiba, Brasil] = Pontifical Catholic University of Paraná [Curitiba, Brazil] = Université catholique pontificale du Paraná [Curitiba, Brésil]
10 Ghent University Hospital
11 CUH - Cambridge University Hospitals - NHS
12 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
13 Hunimed - Humanitas University [Milan]
14 UC San Diego - University of California [San Diego]
15 MCW - Medical College of Wisconsin [Milwaukee]
16 Service d'Hépato-gastro-entérologie [CHRU Nancy]
17 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
Résumé
Therapeutic drug monitoring (TDM) has emerged as a useful tool for optimising the use of biologics, and in particular anti-tumour necrosis factor (anti-TNF) therapy, in inflammatory bowel disease (IBD). However, challenges remain and are hindering the widespread implementation of TDM in clinical practice. These barriers include identification of the optimal drug concentration to target, the lag time between sampling and results, and the proper interpretation of anti-drug antibody titres among different assays. Solutions to overcome these barriers include the harmonisation of TDM assays and the use of point-of-care testing. Other unmet needs include well designed prospective studies and randomised controlled trials focusing on proactive TDM, particularly during induction therapy. Future studies should also investigate the utility of TDM for biologics other than anti-TNF therapies in both IBD and other immune-mediated inflammatory diseases such as rheumatoid arthritis and psoriasis, and the use of pharmacokinetic modelling dashboards and pharmacogenetics towards individual personalised medicine.