Benjamin Click, MD, staff gastroenterologist, the Cleveland Clinic, discusses the role of therapeutic drug monitoring in treating patients with inflammatory bowel disease (IBD).
The idea behind therapeutic drug monitoring, similar to many medications that utilize drug levels to target a therapeutic window of drug level to increase or improve clinical outcomes, is the same for biologic medications in inflammatory bowel disease, mostly with the monoclonal antibodies.
So there are 2 schools of thought regarding therapeutic drug monitoring and inflammatory bowel disease. There's what we call a reactive therapeutic drug monitoring strategy, and what that means is when a patient reports signs or symptoms of active inflammation, and we confirm that active inflammation, then we check the drug level, as well as the antibodies against the drug itself, to see what is the potential reason or mechanism behind this “loss of response” to these to these medications.
The other school of thought is what we call a proactive therapeutic drug monitoring strategy, and this relies on the idea that if we keep the drug in the therapeutic window in a prospective manner, meaning that we check the level on a routine basis as a patient starts the medication before they relapse or potentially display signs of loss of response, then we may improve clinical outcomes and potentially preserve some of our medications in the long run.
We're still doing a lot of research regarding these 2, but I think, generally, the more implemented is the reactive strategy at this point in time, and it's currently recommended by the American Gastroenterological Association guidelines. But I think an exciting opportunity is the proactive strategy as well.