Therapeutic Drug Monitoring | Gastrointestinal Society

Therapeutic Drug Monitoring. Inflammatory bowel disease, or IBD, includes
Crohn’s disease and ulcerative colitis. If you have IBD and are taking certain medications
– called biologics – then your gastroenterologist might suggest therapeutic drug monitoring
for you. Since 2001, physicians have been increasingly
prescribing TNF-α inhibitor biologics, which have revolutionized the treatment of IBD and
other immune-mediated diseases. When taken appropriately, these medications
are effective in reducing disease activity and symptoms, healing the damaged intestine,
and improving quality of life for many IBD patients Despite being in use for some time, we now
know that there may be a more intelligent way to use these drugs. Many patients respond well to the recommended
dose, but some patients fail to respond and others might respond initially, and then lose
their therapeutic benefit over time. Finding a correct dosage for everyone is challenging,
because the medication affects the body of each IBD patient differently. With experience, doctors have discovered that
measuring medication and antibody levels in individual patients allows them to optimize
treatment. For IBD patients taking biologics, the lowest
level of medication present in the body – called trough serum levels – relates closely to
how well patients do on these therapies. Patients in remission have trough levels that
fall within a particular range. Canadian researchers have played a leading
role in these discoveries. The goal of TDM is to maximize the clinical
benefit of a medication while minimizing its side effects. In the fairy tale, Goldilocks and the Three
Bears, Goldilocks tried various dishes of porridge, chairs, and then beds before she
found one that was ‘just right’. TDM helps doctors find the ‘just right’
treatment for their IBD patients. If the biologic dosage is too low, then the
patient will receive no clinical benefit and might build a tolerance to the drug, so doctors
might increase the dose. If the dosage is too high, then the patient
might experience side effects. The treatment becomes ‘just right’ for
the patient when there are as few side effects as possible and the biologic can work as designed,
yielding many benefits and an overall positive treatment outcome. TDM involves a precise blood test, which measures
the amount of biologic medications circulating in your blood at a specific interval during
your treatment. Your doctor will also ask you questions about
any symptoms you might have and will assess these in the context of the test results. If your symptoms return while undergoing treatment,
then be sure to tell your health care professional. TDM can help pinpoint whether you need a dose
adjustment to reclaim and maintain a positive response. Due to the complex nature of biologics and
the unique biology of each individual patient, TDM offers a way to personalize treatment
and increase positive outcomes. We expect that therapeutic drug monitoring
will soon become the gold standard for IBD patients taking biologic medications, as physicians
strive to ensure patients’ treatments are ‘just right’. I’m Dr. Remo Panaccione, and on behalf of the
Medical Advisory Council of the Gastrointestinal Society, thanks for watching. For more information on this topic, including
other animations about IBD, visit

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