My notes from a recent Georgia Chapter of CCFA’s conference. There could be errors of omission, transcription and/or errors in context based on my understanding.

Adam Cheifetz, MD —Harvard School of Medicine

Optimizing IBD Treatments

• Earlier treatment with effective therapies
• Utilizing therapeutic drug monitoring

Goals are clinical and endoscopic remission

• Imaging if not visible on endoscopy
• Biomarker remission -adjunctive goal
• Symptoms and endoscopy do not have good correlation in Crohn’s disease
• Endoscopic healing associated with better outcomes
• Treatment –>assessment –> adjust treatment if goal is not met

Biologic Agents:

• First agent works best; TNF-exposed patients do not respond as well as TNF-naive patients to subsequent biologic
• High rate of secondary loss of response

Therapeutic Drug Monitoring:

• Combination therapy in Sonic study was associated with higher infliximab levels. It appears that optimized monotherapy is as effective as combination therapy (Colombel study).
• Fistula treatment requires higher biologic levels
• Lower biologic drug levels associated with development of antidrug antibodies
• Proactive monitoring –recommended
• Both infliximab and adalimumab are frequently underdosed, especially in pediatrics –>another reason for proactive monitoring
• If sicker patients, consider checking TDM at week 10; less sick patients, reasonable to consider TDM at week 14

Related blog posts:

• Combination Therapy Study Points to Central Role of Adequate Drug Levels
• Appropriate Proactive Therapeutic Drug Monitoring
• Can Therapeutic Drug Monitoring with Monotherapy Achieve Similar Results as Combination Therapy for IBD?
• Briefly Noted: Induction Infliximab Levels Infliximab level ≥18 mcg/mL at week 6 was strongly associated with clinical and biologic response as well as achieving an infliximab level ≥5 mcg/mL at week 14 (AUC 0.85).
• Is Standard Infliximab Dose Too Low in Pediatrics?
• Can Therapeutic Drug Monitoring with Monotherapy Achieve Similar Results as Combination Therapy for IBD? | gutsandgrowth The authors utilized TDM at week 10.  If the IFX level was <20 mcg/mL, the dose and frequency of infliximab were both adjusted. If the level was between 20 & 25, either the frequency was adjusted or no adjustment, and if the level was >25, then no adjustment in dosing was performed.
• Don’t be Fooled About Withdrawing Immunomodulator Cotherapy -Look Past the Headline

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.