Area Editoriale
Therapeutic drug monitoring (TDM) has emerged as a strategy for treatment optimization in inflammatory bowel diseases in order to maximise benefit and to reach more stringent, objective endpoints. Optimal drug concentrations in IBD vary according to treatment target, disease phenotype, inflammatory burden and timing of sampling during the treatment cycle.This review provides an update on TDM with biologic and oral small-molecules, evaluates the role of reactive versus proactive TDM and identifies the gaps in current evidence. In the future, adaptations to how we use TDM may contribute further to the goal of personalizedtreatment in patients with IBD.
Conclusions
The use of TDM in IBD continues to evolve. Whilst the number of therapeutic options continues to expand, perhaps decreasing the need for TDM-based drug optimisation, in some clinical situations, such as perianal fistulising CD and ASUC, treatment options remain limited.
In addition, given that for some patients with IBD the disease is progressive, there is a clear incentive to use each drug in an optimal fashion from the outset in order to control disease effectively and quickly. Finally, it is important to remember that our ability to achieve steroidfree clinical and endoscopic remission, let alone histological remission, is limited to a minority of patients; where TDM is able to facilitate more effective drug use, it is likely to have a role to play for the foreseeable future.
It is important to remember that TDM represents a small part of the assessment of patients with IBD and, whilst we believe that its use can enhance clinical care, decision making based solely on TDM has the potential to harm. Bearing this in mind, we present a pragmatic approach to its use in IBD.