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Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease

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Pediatric Inflammatory Bowel Disease

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Abstract

Therapeutic drug monitoring (TDM) is the clinical practice of measuring drug concentrations to attain a targeted serum concentration and thus optimize individual dosage regimens. TDM has emerged as a necessary mechanism to enhance drug efficacy to achieve optimal outcomes. Examples include the well-established relationship of the genetic variability of thiopurine metabolism driven by the thiopurine S-methyltransferase (TPMT) pathway and recent emerging data supporting the pharmacokinetic variability and immunogenicity with antitumor necrosis factor (TNF) therapies. In this chapter, we review the data describing the relationship between drug concentrations and outcomes. The effect of antidrug antibodies on drug efficacy and toxicity has been established. Furthermore, we describe different assays which are used in measuring these drug and antibody concentrations. An algorithm is proposed for clinical practitioners to utilize TDM in patients losing clinical response to anti-TNF therapy. A proactive, rather than reactive, approach to TDM of anti-TNF agents is supported by emerging data and will provide practitioners with the tools needed to optimally treat young IBD patients.

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Author information

Authors and Affiliations

  1. Pediatric IBD Center at Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Namita Singh MD

  2. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Namita Singh MD

  3. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Marla C. Dubinsky MD

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  1. Namita Singh MD
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  2. Marla C. Dubinsky MD
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Correspondence to Namita Singh MD .

Editor information

Editors and Affiliations

  1. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Petar Mamula

  2. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Andrew B. Grossman

  3. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Robert N. Baldassano

  4. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Judith R. Kelsen

  5. Division of Pediatric Gastroenterology & Nutrition, University of South Carolina School of Medicine - Greenville, Greenville, South Carolina, USA

    Jonathan E. Markowitz

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Singh, N., Dubinsky, M.C. (2017). Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease. In: Mamula, P., Grossman, A., Baldassano, R., Kelsen, J., Markowitz, J. (eds) Pediatric Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-49215-5_34

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  • DOI: https://doi.org/10.1007/978-3-319-49215-5_34

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