Gastroenterology
Advancing drug monitoring for better IBD outcomes
CSJ recently hosted a webinar, sponsored by BIOHIT HealthCare, exploring current and future trends in therapeutic drug monitoring (TDM) for inflammatory bowel disease (IBD) management. Graham Johnson delves into the key points discussed by experts during the session, highlighting the importance of early treatment optimisation, the use of TDM to prevent therapeutic setbacks, and promising new technologies that are advancing patient management.
Gastrointestinal disorders are increasingly recognised as a global health challenge, with rising incidence rates and substantial implications for the general population. In fact, research conducted in 2022 revealed that over half a million people in the UK alone are living with Crohn’s disease and ulcerative colitis – nearly double that of previous estimates.1
This
equates to a prevalence of approximately 1 in every 123 individuals, and the incidence of gastrointestinal disorders is projected to continue to rise in the coming decades.2 Fortunately, this growing disease burden is being counteracted by significant strides in pharmacological IBD management, particularly through the development of biologic treatments like the TNF-α inhibitors infliximab (IFX) and adalimumab (ADM). Biologics and biosimilars – more affordable biotherapeutic medicines with highly similar structures, functions and
efficacy to the original drugs – offer a distinct advantage over systemic small molecule anti-inflammatories, due to their direct mode of action.3,4
These therapies have transformed
IBD care by targeting and inhibiting pro- inflammatory cytokines, markedly reducing the need for surgical interventions5
since
their integration into routine clinical practice. However, the chronic and often unpredictable nature of IBD continues to pose significant challenges for both patients and healthcare providers. Responses to biotherapies vary widely, from rapid remission in some patients to no therapeutic effect in others. It is not therefore uncommon for patients to experience limited benefit from these treatments; up to 30 per cent of IBD patients show no initial response, and as many as 46 per cent encounter a gradual loss of response (LOR) to biotherapeutics over time.6
Common roadblocks to optimal IBD care Understanding how the body metabolises and eliminates anti-TNF drugs is crucial to effective IBD management. Medications like IFX and ADM are cleared through several complex pathways, including proteolysis, loss through mucosal barriers during severe flare-ups, and binding to TNF-α molecules.7
In patients experiencing
high inflammation levels, substantial amounts of TNF-α inhibitors may be eliminated through these processes, requiring dose adjustments to maintain therapeutic levels. Moreover, treatment efficacy is closely linked to numerous patient-specific characteristics that can increase risk of immunogenicity.8
The individual nature of treatment responses The personalised anti-TNF therapy in Crohn’s disease study (PANTS)8
is a UK-wide study that
investigated treatment responses among IBD patients. The prospective observational study, published in The Lancet Gastroenterology & Hepatology, identified several factors linked to primary non-response or non-remission in patients receiving IFX and ADM. These include patient characteristics such as obesity and smoking, both of which are associated with a higher risk of subtherapeutic drug levels. Genetic markers – like the HLA-DQA1*05 allele – can also influence drug responses by predisposing some patients to heightened immune responses, further complicating treatment.
Immunogenicity: a key obstacle in effective treatment LOR often arises from an immunogenic response in which the body develops anti- drug antibodies (ADAs) that can neutralise the therapeutic effect of the drug.9
This immune March 2025 I
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