April 15, 2019
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Finding consensus for biologic therapeutic drug monitoring in IBD

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Adam Cheifetz
Adam Cheifetz

Biologic therapies have changed the way inflammatory bowel disease is treated, but subtherapeutic drug concentrations still result in loss of response in many patients.

In a consensus statement published in Clinical Gastroenterology and Hepatology, Adam Cheifetz, MD, director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center, and colleagues sought to determine how clinicians can use therapeutic drug monitoring (TDM) to improve treatment.

“There is a significant amount of data to suggest that adequate biologic concentrations are associated with beneficial outcomes in IBD,” Cheifetz told Healio Gastroenterology and Liver Disease. “Despite many publications on both reactive and proactive TDM, there is still a debate on when and how to use TDM. Our goal was to reach a consensus and when and how to utilize TDM in the treatment of IBD and to identify target drug concentrations for each of the biologics.”

Cheifetz and colleagues performed a comprehensive literature review and presented 28 statements on the application of TDM to a group of international IBD specialists. Each panelist rated the statements on a scale of 1 to 10 (1 = strongly disagree and 10 = strongly agree). If 80% of the group agreed on a statement with a score of at least 7, the group included it in the consensus.

The group agreed on 24 of the 28 original statements (86%).

In their assessment of proactive TDM, the group agreed that it was appropriate after induction of anti-TNF therapy and at least once during maintenance. However, Cheifetz said this was not the case for other biologics.

Additionally, the groups agreed that reactive TDM was appropriate for all biologic agents for both primary and secondary loss of response. More research is needed to find the precise levels for optimal concentration for other non-anti-TNF therapies.

“We agreed on minimum trough concentrations with each of the biologics, at specific time points — like induction, post-induction, and maintenance — based on specific endpoints,” Cheifetz said in an interview. “We created a Biologic Therapy Optimizer to help guide clinician’s decision making based on the recommendations from this consensus meeting.” – by Alex Young

Disclosures: Cheifetz reports serving on advisory boards for AbbVie, Arena, Bacainn, Janssen, Pfizer, Samsung and Takeda. He reports receiving research support from Miraca. Please see the full study for all other authors’ relevant financial disclosures.