Is There Still a Role for Proactive Therapeutic Drug Monitoring (TDM) in Inflammatory Bowel Disease (IBD): A Review of the Literature
DOI:
https://doi.org/10.58931/cibdt.2025.3142Abstract
The management of biologic medications in inflammatory bowel disease (IBD) is complex due to the inter- and intra-individual variability in pharmacokinetics and pharmacodynamics. There exist important differences in drug uptake and metabolism depending on a variety of factors including dosing intervals, route of administration, gender, body weight, albumin levels, inflammation, immunogenicity, genetic variation and other concurrent therapies. Males and individuals with higher body weight exhibit increased drug clearance, and certain biologics are more immunogenic than others. Moreover, the presence of a high inflammatory state, as demonstrated by elevated CRP levels and low albumin levels, also increase drug clearance and are associated with worse clinical outcomes.
Therapeutic drug monitoring (TDM) can be useful in titrating certain biologic medications in IBD patients. By measuring drug levels and screening for antibody formation, TDM allows physicians to evaluate and optimize response to medications. Using these values, physicians can determine whether patients are sub-optimally dosed and can benefit from a reinduction or dose escalation, or whether these patients have begun developing immune responses to these medications.
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