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Evidence Supporting High-Dose Use of Biologics in Clinical Practice

  • Inflammatory Bowel Disease (G Lichtenstein, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

Biologic therapies have transformed the management of inflammatory bowel disease (IBD). However, a significant proportion of patients demonstrate primary non-response (PNR) or develop a secondary loss of response (LOR) to these agents. Studies using therapeutic drug monitoring (TDM) have demonstrated a correlation between drug concentration and improved outcomes and that inadequate drug concentrations may be accountable for a significant proportion of PNR and LOR. This review aims to evaluate the role for high-dose biologic therapy in the treatment of IBD.

Recent findings

Several studies have demonstrated an important role for dose optimization of anti-TNF agents to achieve desired therapeutic outcomes. More recently, there is also evidence for dose optimization and empiric dose escalation of vedolizumab and ustekinumab. With anti-TNF agents, dose optimization results in improved therapeutic outcomes by controlling inflammation and reducing immunogenicity. Immunogenicity may play less of a role with vedolizumab and ustekinumab.

Summary

There is a role for TDM to guide dose optimization of biologics in IBD. Further prospective studies are needed to determine if there is a role for accelerated induction therapy with these agents and to evaluate target trough concentrations for vedolizumab and ustekinumab.

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Authors and Affiliations

  1. Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA

    Sarah E. Shannahan M.D., Konstantinos Papamichael Ph.D., M.D. & Adam S. Cheifetz M.D.

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  1. Sarah E. Shannahan M.D.
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  2. Konstantinos Papamichael Ph.D., M.D.
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Authored first draft (SS); critical revisions (KM, AC); approved final draft (SS, KM, AC).

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Correspondence to Adam S. Cheifetz M.D..

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Conflict of Interest

Dr. Sarah E. Shannahan has no potential conflicts of interest.

Dr. Konstantinos Papamichael has received a lecture fee from Mitsubishi Tanabe Pharma, unrelated to the submitted work.

Dr. Adam S. Cheifetz has received consulting fees from Janssen, Abbvie, Pfizer, Takeda, Samsung, Arena, Prometheus, Grifols, Arsanis, Bacainn, EMD Serono, AlfaSigma, and AMAG. He received grants from Inform Diagnostics. These are all unrelated to the submitted work.

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Shannahan, S.E., Papamichael, K. & Cheifetz, A.S. Evidence Supporting High-Dose Use of Biologics in Clinical Practice. Curr Treat Options Gastro 18, 408–422 (2020). https://doi.org/10.1007/s11938-020-00302-1

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