Therapeutic Drug Monitoring to Guide Clinical Decision Making in Inflammatory Bowel Disease Patients with Loss of Response to Anti-TNF: A Delphi Technique-Based Consensus.

Greuter, Thomas; Maillard, Michel H; Juillerat, Pascal; Michetti, Pierre; Seibold, Frank; Mottet, Christian; Zahnd, Nadine; Sauter, Bernhard; Schoepfer, Alain M; Rogler, Gerhard; Vavricka, Stephan R (2020). Therapeutic Drug Monitoring to Guide Clinical Decision Making in Inflammatory Bowel Disease Patients with Loss of Response to Anti-TNF: A Delphi Technique-Based Consensus. Digestion, 101(6), pp. 683-691. Karger 10.1159/000501930

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BACKGROUND

Loss of response is frequently encountered in patients with inflammatory bowel disease (IBD) treated with antitumor necrosis factor (TNF) agents. Therapeutic drug monitoring (TDM) and antidrug antibody measurement are increasingly used in this setting.

METHODS

To establish a consensus on the use of TDM in the context of loss of response to anti-TNFs, we performed a vote using a Delphi-style process followed by an expert panel discussion among 8 IBD specialists practicing in Switzerland, Europe. Statements were rated on an even Likert-scale ranging from 1 (strong disagreement) to 4 (strong agreement), based on expert opinion and the available literature.

RESULTS

The experts agreed on the following statements: (i) loss of response is associated with inadequate drug levels in both Crohn's disease and ulcerative colitis; (ii) best timepoint for measuring drug levels is prior to the next application (= trough levels) with different thresholds for anti-TNF agents (infliximab 5 μg/mL, adalimumab 8 μg/mL, certolizumab pegol 10 μg/mL); (iii) antidrug antibodies are predictive for loss of response; and (iv) antidrug-antibody titers and drug trough levels are key determinants in the treatment algorithm. Data about non-anti-TNF biologics were considered too limited to propose recommendations.

CONCLUSION

A Delphi-style consensus among 8 IBD experts shows that TDM and measurement of antidrug-antibody titers are useful in the context of loss of response to anti-TNF. Optimal cutoff levels depend on the type of anti-TNF. These values are critical in the decision making process. More studies are needed to address the value of such measurements for non-anti-TNF biologics.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology

UniBE Contributor:

Juillerat, Pascal

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0012-2823

Publisher:

Karger

Language:

English

Submitter:

Thi Thao Anh Pham

Date Deposited:

30 Jan 2020 14:19

Last Modified:

14 Nov 2020 01:30

Publisher DOI:

10.1159/000501930

PubMed ID:

31461706

Uncontrolled Keywords:

Antidrug antibodies Antitumor necrosis factor Consensus Inflammatory bowel disease Loss of response Therapeutic drug monitoring

URI:

https://boris.unibe.ch/id/eprint/138201

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