Practical aspects of proactive TDM for Anti-TNF agents in IBD: Defining time points and thresholds to target

Abstract

Serum biologic drug concentrations have been associated with favorable therapeutic outcomes in inflammatory bowel diseases, while low or undetectable drug levels have been linked to immunogenicity and treatment failure. Therapeutic drug monitoring (TDM) in the context of clinical relapse can guide decision making and is supported by professional groups. Proactive TDM consists of measurement of trough concentration with the goal of optimizing drug concentration in patients with clinical response/remission. Recent findings suggest that this approach can improve the efficacy of antitumor necrosis factor agents (anti-TNF). In this article, we summarize the rationale for proactive TDM for anti-TNF agents in practice, identify limitations in this evidence base, and provide practical advice for use in the clinic.