Therapeutic Drug Monitoring of Anti-TNF Therapy in Inflammatory Bowel Disease
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While anti-TNF agents have had a marked impact in the treatment of inflammatory bowel disease, a significant number of patients lose their response to these medications over time. Clinical trials have demonstrated that antibodies against anti-TNF medications may impact treatment response and increase the risk of infusion reaction. Scheduled dosing and concurrent use of immunomodulators may help to mitigate these risks via inhibiting the formation of these antibodies. The recent availability of assays to measure anti-TNF drug levels and antibodies against anti-TNFs offer the opportunity to assess patients who have lost response with infliximab and adalimumab, and potentially determine the most appropriate therapeutic strategy. There is growing evidence that such testing improves patient outcomes and is cost-effective, although heterogeneity in the assays used in clinical and observational trials has resulted in mixed results.
KeywordsInfliximab Adalimumab Certolizumab Azathioprine Immunomodulators Tumor necrosis factor-alpha (TNF-a) Anti-TNF drug levels Biologic Antibodies to infliximab (ATIs) Antibodies to adalimumab (ATAs) Crohn’s disease Ulcerative colitis
Compliance with Ethics Guidelines
Conflict of Interest
Frank I. Scott declares that he has no conflict of interest.
Gary R. Lichtenstein has received consultancy payments from Abbott Corporation/Abbvie, Alaven, Bristol-Myers Squibb, Elan, Ferring, Hospira, Janssen Orthobiotech, Millenium Pharmaceuticals, Ono Pharmaceuticals, Pfizer Pharmaceuticals, Prometheus Laboratories, Inc., Salix Pharmaceuticals, Santarus, Shire Pharmaceuticals, Takeda, UCB, and Warner; honoraria from Ironwood and Luitpold / American Regent; and a research grant from Warner Chilcotte.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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