Articles and papers

Therapeutic drug monitoring (TDM) of Infliximab (IFX) and Adalimumab (ADAL) has been in use in our centre since 2012. Here we present the TDM experience of our laboratory service at Viapath, St Thomas’ Hospital.

The development of adalimumab (Ada) drug and antibody testing has allowed a personalised approach to complex inflammatory bowel disease (IBD) treatment. We present our 2-year experience at a tertiary IBD referral centre.

Clinical trial results suggest that measurement of antiTNF drug levels (ATL) and antibodies (ATA) may have a cost-saving as well as clinically beneficial effect in patients with IBD. We aimed to assess whether selective monitoring of ATL and ATA reduces prescribing costs and how it affects clinical decisions in ordinary clinical practice.

Therapeutic drug monitoring (TDM) of Infliximab (IFX) has been in use in our centre since 2012 and has become increasingly widespread in the UK with the availability of several CE marked assays. TDM of IFX is useful in optimisation of therapy in patients with inflammatory bowel disease (IBD). The detection of antibodies against Infliximab can guide clinical decision making with regard to dose escalation, immunomodulation or drug switching / withdrawal. However the utility of measuring free versus total (IFX-complex + free) anti-Infliximab antibody (ADAb) remains debatable, further complicated by lack of assay standardisation.

Therapeutic drug monitoring (TDM) of infliximab (IFX) is useful in patients with inflammatory bowel disease (IBD). Therapeutic cut-offs to predict active disease and the influence of thiopurines on drug levels (DL) according to 6-thioguanine nucleotide (TGN) are not defined. There is limited data on the utility of free anti-drug antibodies (ADAb) against total ADAb. We assessed the utility of TDM of IFX in IBD using a commercially available ELISA and investigated the influence of TGNs on DL and free/total ADAb.

Some, but not all, studies have demonstrated a relationship between therapeutic drug monitoring (TDM) of adalimumab (ADA) and outcomes in Crohn's disease (CD). We evaluated the utility of TDM of ADA in patients with CD using two commercially-available ELISA.