title: Clinical impact of immunomonitoring in the treatment of inflammatory bowel disease.
abstract: Despite improvement in outcomes, loss of response (LOR) to tumor necrosis factor-alpha (TNFα) therapies is a big concern in the management of inflammatory bowel disease. LOR is associated with flares of disease, increased hospitalisation rates, need for surgical interventions, and decline in quality of life. LOR may be multifactorial, but immunogenicity makes a significant contribution. Traditionally doses of anti-TNFα have been adjusted based on clinical response, using a standard approach. Immunomonitoring involves the measurement of anti-TNFα trough and antibody levels. It takes into account the underlying pharmacokinetics of anti-TNFα therapies. Expanding on this a treat to target approach may be used, where doses are intensified, or tailored to the individual based on the measurement of anti-TNFα trough and antibody levels. This review looks at the history, evolution, and clinical impact that immunomonitoring is having in the treatment of inflammatory bowel disease. It will focus on the role of immunomonitoring in helping to achieve long lasting deep remission and mucosal healing. It will explore the different options in terms of best measuring trough and antibody levels, explore possible advantages of immunomonitoring, and discuss its role in best optimising response, at induction, during the maintenance phase of treatment, as well as a role in withdrawing or switching therapy.
authors.affiliation: Donal Tighe, Deirdre McNamara, Department of Gastroenterology, Adelaide and Meath Incorporating the National Children's Hospital Tallaght, School of Clinical Medicine, Trinity College Dublin, Trinity Academic Gastroenterology Group, Dublin 24, Ireland.
authors.forename: Donal
authors.initials: D
authors.lastname: Tighe
authors.affiliation: Donal Tighe, Deirdre McNamara, Department of Gastroenterology, Adelaide and Meath Incorporating the National Children's Hospital Tallaght, School of Clinical Medicine, Trinity College Dublin, Trinity Academic Gastroenterology Group, Dublin 24, Ireland.
authors.forename: Deirdre
authors.initials: D
authors.lastname: McNamara
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D004351:Drug Resistance / Q000276:immunology*; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology*; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology* / Q000627:therapeutic use; D015166:Monitoring, Immunologic; D011788:Quality of Life; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D001379:Azathioprine
keywords: Anti-TNFα trough and antibody levels; Crohn's disease; Immunomonitoring; Inflammatory bowel disease; Ulcerative colitis; immunogenicity; loss of response