AGA Releases New Guidelines For Therapeutic Drug Monitoring in IBD

The American Gastroenterological Association (AGA) recently released new guidelines on therapeutic drug monitoring (TDM) of patients with inflammatory bowel disease (IBD).

“This guideline was developed to inform appropriate utilization of TDM with anti-tumor necrosis factor (TNF)-α agents and thiopurines,” the authors wrote.
______________________________________________________________________________________________________________________________________________
RELATED CONTENT
Anti-TNF Therapy May Increase Risk for IBD
Why Do Some IBD Patients Have Poor Response to Treatment?
______________________________________________________________________________________________________________________________________________
Among the recommendations:

• For adults with active IBD who are receiving anti-TNF agents, the AGA suggested the use of reactive TDM to guide treatment changes.
• The AGA suggested routine TPMT testing, either enzymatic activity or genotype, to guide thiopurine dosing before adult patients with IBD initiate thiopurine therapy.
• For adult patients receiving thiopurines who have active IBD or may be experiencing thiopurine-related adverse effects, the AGA suggested reactive thiopurine metabolite monitoring to guide treatment changes.
• The AGA had no recommendation for the use of routine proactive TDM for adult patients with inactive IBD who are receiving anti-TNF agents.

In addition, the guidelines included a technical review of the evidence used to support each recommendation and a clinical decision support tool to help physicians determine when to perform TDM and how to interpret the results.

—Melissa Weiss

Reference:

Feuerstein JD, Nguyen GC, Kupfer SS, Falck-Ytter, Singh S. American Gastroenterological Association institute guideline on therapeutic drug monitoring in inflammatory bowel disease [published online August 3, 2017]. Gastroenterology. https://dx.doi.org/10.1053/j.gastro.2017.07.032.