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World J Gastroenterol. Jun 7, 2022; 28(21): 2282-2290
Published online Jun 7, 2022. doi: 10.3748/wjg.v28.i21.2282
Updates in therapeutic drug monitoring in inflammatory bowel disease
Nilesh Lodhia, Shanti Rao
Nilesh Lodhia, Shanti Rao, Department of Gastroenterology and Hepatology, Atrium Health, Charlotte, NC 28203, United States
Author contributions: Rao S reviewed prior publications and composed the paper; Lodhia N revised the paper.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nilesh Lodhia, MD, Associate Professor, Department of Gastroenterology and Hepatology, Atrium Health, CHS Digestive Health 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28203, United States. nilesh.lodhia@atriumhealth.org
Received: November 22, 2021
Peer-review started: November 22, 2021
First decision: December 27, 2021
Revised: January 9, 2021
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: June 7, 2022
Processing time: 191 Days and 16 Hours
Abstract

Biologics and immunomodulators (IMM) are generally considered the most effective therapies for the treatment of ulcerative colitis and Crohn’s disease. However, despite the efficacy of these therapies, many patients either have a primary lack of response or a secondary loss of response to these medications. Therapeutic drug monitoring (TDM) is a systematic approach to managing such patients. In this review, we summarize the latest data on TDM, including reactive and proactive TDM, in patients with inflammatory bowel disease on biologics and/or IMM.

Keywords: Inflammatory bowel disease; Therapeutic drug monitoring; Crohn’s disease; Ulcerative colitis

Core Tip: Inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn’s disease, are best treated with immunomodulators (IMM) or biologics. The rate of response clinically and endoscopically varies between the medications and within patient populations. Therapeutic drug monitoring (TDM) is a useful technique to assess drug and metabolite levels as well as anti-drug levels in patients on biologics or IMM in order to improve clinical outcome and prevent a multitude of complications. Here we discuss the role of TDM in patients with IBD with a focus on reactive vs proactive TDM.