February 27, 2019
1 min read

Proactive Humira drug monitoring may lower treatment failure risk in IBD

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Adam Cheifetz

Proactive therapeutic drug monitoring with Humira could help reduce the risk for treatment failure in patients with inflammatory bowel disease, according to results of a retrospective cohort.

Adam S. Cheifetz, MD, director of the center for IBD at Beth Israel Deaconess Medical Center and Harvard Medical School said research has demonstrated that therapeutic drug monitoring (TDM) is effective for optimizing anti-TNF therapy in patients with IBD, but most studies have focused on reactive testing of Remicade (infliximab, Janssen).

“We have previously shown that proactive TDM with infliximab was associated with better outcomes than empiric dose escalation or reactive TDM,” Cheifetz told Healio Gastroenterology and Liver Disease. “In this study, we aimed to compare the long-term outcome of patients with IBD who received at least one proactive TDM of [Humira, adalimumab, AbbVie] with standard of care.”

Researchers conducted a multicenter retrospective cohort study comprising 382 patients with IBD who received at least one proactive TDM (n = 53) or standard of care, defined as empirical dose escalation (n = 279) or reactive TDM (n = 50). Investigators assessed time to treatment failure — defined as drug discontinuation for secondary loss of response, serious adverse event or need for IBD-related surgery — from the start of adalimumab therapy until the end of the follow-up period (median 3.1 years).

Cheifetz said their analysis found that at least one proactive TDM was independently associated with a reduced risk for treatment failure (HR = 0.4; 95% CI, 0.2–0.9).

Additionally, patients with treatment failure had lower adalimumab concentration at first TDM (median interquartile range = 8.9; 3.7–14.3) compared with patients without treatment failure (median IQR = 14.1; 8.2–19.7; P = .002). An adalimumab concentration threshold of 11.7 µg/mL stratified patients with or without treatment failure.

Cheifetz said this is the first study to show the potential benefits of proactive TDM with adalimumab compared with standard of care.

“Consideration may be given to proactive TDM, and not only reactive TDM or empiric dose escalation, when optimizing adalimumab therapy,” he said. – by Alex Young

Disclosures: Cheifetz reports consulting fees from AbbVie, AMAG, Arena, Ferring, Janssen, Miraca, Pfizer, Samsung and Takeda. He also reports research support from Miraca. Please see the full study for all other authors’ relevant financial disclosures.