title: Review article: a clinician's guide for therapeutic drug monitoring of infliximab in inflammatory bowel disease.
abstract: BACKGROUND
  Tumour necrosis factor (TNF)-antagonists have an established role in the treatment of inflammatory bowel diseases (IBDs), however, subtherapeutic drug levels and the formation of anti-drug antibodies (ADAs) may decrease their efficacy.
  
  
  OBJECTIVE
  The evidence supporting the use of therapeutic drug monitoring (TDM) based clinical algorithms for infliximab (IFX) and their role in clinical practice will be discussed.
  
  
  METHODS
  The literature was reviewed to identify relevant articles on the measurement of IFX levels and antibodies-to-infliximab.
  
  
  RESULTS
  Treatment algorithms for IBD have evolved from episodic monotherapy used in patients refractory to all other treatments, to long-term combination therapy initiated early in the disease course. Improved remission rates have been observed with this paradigm shift, nevertheless many patients ultimately lose response to therapy. Although empiric dose optimization or switching agents constitute the current standard of care for secondary failure, these interventions have not been applied in an evidence-based manner and are probably not cost-effective. Multiple TDM-based algorithms have been developed to identify patients that may benefit from measurement of IFX and ADA levels to guide adjustments to therapy.
  
  
  CONCLUSIONS
  Therapeutic drug monitoring offers a rational approach to the management of secondary failure to IFX. This concept has gained momentum based on evidence from case series, cohort studies and post-hoc analyses of randomised controlled trials.
authors.affiliation: Robarts Clinical Trials Inc., Robarts Research Institute, Western University, London, ON, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Khanna
authors.forename: B D
authors.initials: BD
authors.lastname: Sattin
authors.forename: W
authors.initials: W
authors.lastname: Afif
authors.forename: E I
authors.initials: EI
authors.lastname: Benchimol
authors.forename: E-J
authors.initials: EJ
authors.lastname: Bernard
authors.forename: A
authors.initials: A
authors.lastname: Bitton
authors.forename: B
authors.initials: B
authors.lastname: Bressler
authors.forename: R N
authors.initials: RN
authors.lastname: Fedorak
authors.forename: S
authors.initials: S
authors.lastname: Ghosh
authors.forename: G R
authors.initials: GR
authors.lastname: Greenberg
authors.forename: J K
authors.initials: JK
authors.lastname: Marshall
authors.forename: R
authors.initials: R
authors.lastname: Panaccione
authors.forename: E G
authors.initials: EG
authors.lastname: Seidman
authors.forename: M S
authors.initials: MS
authors.lastname: Silverberg
authors.forename: A H
authors.initials: AH
authors.lastname: Steinhart
authors.forename: R
authors.initials: R
authors.lastname: Sy
authors.forename: G
authors.initials: G
authors.lastname: Van Assche
authors.forename: T D
authors.initials: TD
authors.lastname: Walters
authors.forename: W J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: B G
authors.initials: BG
authors.lastname: Feagan
mesh_terms: D000465:Algorithms; D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005765:Gastrointestinal Agents / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology; D000069285:Infliximab; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab