Gastroenterology
of targets will continue to make this possible. However, it is critical for clinicians to also understand when and why a patient is beginning to develop drug unresponsiveness in order to re-evaluate their treatment plan and instigate alternative therapies. TDM of TNF-α inhibitor trough levels and
ADAs have already shown promising results for guiding the appropriate management of patients with loss of response when used reactively in clinical care.6
Assays – such as
the IDKmonitor Infliximab Total Anti-drug ELISA (BIOHIT HealthCare) – can detect bound and free ADAs in the patient’s bloodstream, helping to identify patients with low-titre ADAs. Armed with this information, clinicians can tailor their treatment plans accordingly, to prevent future lack of response or optimise doses to avoid undertreatment, hopefully leading to better long-term outcomes for IBD patients.
An era of point-of-care testing Currently, the process of TDM is relatively straightforward with samples taken during appointments and sent away to a specialist laboratory that will run the assay for the appropriate analyte and return the results to the clinician. However, there is much discussion in the IBD healthcare community about the introduction of point-of-care TDM, which can be performed during an appointment, eliminating the time lost when transporting samples to a
laboratory and providing information to direct patient infusions that same day. On the face of it, this seems like an obvious progression – particularly considering the success of other point-of-care testing programmes, but it is important to evaluate exactly how this may fit into the management of IBD, both now and in the future, to ensure longevity and consistency for patients.
From hospital- to home-based medicine The first consideration revolves around the fact that IBD therapies have evolved to not only include more targets, but also to provide different mechanisms of drug delivery. In the last few years, these treatments have progressed from hospital-based intravenous drug delivery to subcutaneous infliximab injections, offering patients the opportunity to self-administer their medication.7
The success
of this was reported in the REM-SWITCH study, which demonstrated that transitioning IBD patients to subcutaneous injections was safe and well accepted, with a low risk of relapse.8 Several forward-thinking pharmaceutical companies are now looking at developing novel oral drug delivery programmes, providing patient-friendly agents including TNF-α inhibitors and other biological therapies, that can be easily taken within the comfort of the patient’s home,7
reducing the reliance on
hospital-based services. These promising oral candidates have shown the ability to survive the transition to the gastrointestinal tract, and reach the mucosa of the bowel for targeted drug delivery. Being able to self-administer sub- cutaneous and oral medication outside the bounds of a hospital could have several benefits for patients, giving them greater ownership over their condition, as well as improving the convenience of therapy, reducing the costs associated with travel, and giving them back time that would have been otherwise spent in a hospital. Healthcare institutions also stand to gain from this
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www.clinicalservicesjournal.com I May 2024
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