title: Therapeutic drug monitoring of anti-TNF-α agents in inflammatory bowel diseases.
abstract: BACKGROUND
  The elaboration of effective and cost-saving algorithms for anti-TNF optimization in patients with inflammatory bowel diseases (IBD) represents one of the biggest challenges over the last few years. Recently, many studies have been focused on the identification of an optimal trough level (TL) for most used anti-TNF agents and on the role of anti-drug antibodies (ADAs), especially in the management of patients who lose response to biological treatments. Therapeutic drug monitoring may potentially help to also prevent lose of clinical benefit overtime and to reduce health-related costs.
  
  
  METHODS
  Current evidence about the correlation between clinical outcomes and anti-TNF TLs, the role of ADAs in the context of safety and loss of response to anti-TNF, the utility of therapeutic drug monitoring in clinical practice.
  
  
  CONCLUSIONS
  The data available so far support the utility of TL and ADA measurement for the management of IBD patients with loss of response to anti-TNF but does not currently authorizes a routine application in clinical practice of proactive therapeutic monitoring in patients in clinical remission. However, this remains a promising approach to optimize anti-TNF therapies and possibly to reduce health-related costs, then further prospective studies are strongly expected.
authors.affiliation: Catholic University, IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus , Via Moscati 31-33, 00168 Rome , Italy +39 0 6350 3310 ; +39 0 6305 4641 ; alearmuzzi@yahoo.com.
authors.forename: Carla
authors.initials: C
authors.lastname: Felice
authors.forename: Manuela
authors.initials: M
authors.lastname: Marzo
authors.forename: Daniela
authors.initials: D
authors.lastname: Pugliese
authors.forename: Alfredo
authors.initials: A
authors.lastname: Papa
authors.forename: Gian Lodovico
authors.initials: GL
authors.lastname: Rapaccini
authors.forename: Luisa
authors.initials: L
authors.lastname: Guidi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armuzzi
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000097:blood / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000097:blood / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000097:blood
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha
keywords: anti-TNF; anti-drug antibody; inflammatory bowel disease; therapeutic drug monitoring; trough level