title: The Evolving Evidence for Therapeutic Drug Monitoring of Monoclonal Antibodies in Inflammatory Bowel Disease.
abstract: OBJECTIVE
  Biological medications are effective in inflammatory bowel disease (IBD) but adverse events, cost, and loss of response make their use challenging. Therapeutic drug monitoring (TDM) allows clinicians to more safely, effectively, and efficiently use medications. The purpose of this article is to review and summarize the most recent literature pertaining to TDM in IBD.
  
  
  RESULTS
  Measurement of biological drug trough levels predicts ongoing patient response and can be used to titrate the medication to be more effective and efficient. Antibodies against the medications predict loss of response and adverse events. Using both parameters can predict response to subsequent biologicals. Newer biologicals show similar characteristics to those more commonly used. Management protocols using drug and antibody levels optimize medication use and may be cost-effective. Recent evidence suggests benefit to TDM of biologicals in IBD.
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Joseph and Wolf Lebovic Health Complex, 437-600 University Avenue, Toronto, ON, M5G 1X5, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sheasgreen
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Joseph and Wolf Lebovic Health Complex, 437-600 University Avenue, Toronto, ON, M5G 1X5, Canada. geoff.nguyen@utoronto.ca.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents
keywords: Antibodies to drug; Biologic therapy; Crohn’s disease; Inflammatory bowel disease; Therapeutic drug monitoring; Trough level; Ulcerative colitis