Dr Cross gives an overview of his talk on therapeutic drug monitoring in IBD from the Advances in Inflammatory Bowel Disease 2022 Regional Meeting.

Raymond Cross, MD, is a professor of medicine and director of the Inflammatory Bowel Disease Program at the University of Maryland School of Medicine in Baltimore, Maryland.

TRANSCRIPT

Ray Cross, MD:
Hello, everyone. I'm Raymond Cross from the University of Maryland School of Medicine, and I'm going to review a talk I gave at the Regional Advances in IBD on April 2nd in Raleigh, entitled Therapeutic Drug Monitoring in IBD. During this talk, I reviewed the various drug levels that are targets, with the approved biologics that we use in clinical practice. Importantly, we talk about different strategies for therapeutic drug monitoring. Our society guidelines strongly recommend that we check drug levels, particularly in patients being treated with anti-TNF that have an inadequate or loss of response to therapy. So I think that's fairly clear cut. And we emphasize again that if you have low drug without significant antidrug antibodies, that we would attempt to dose escalate the patient. If we have low drug levels and high antidrug, tighter antibodies, we're going to change therapies, often within the class, if it's a loss of response that a patient has.

Those that have good drug levels without antidrug antibodies, the most important point that I emphasized is that we need to verify that the patient actually has active inflammation before changing treatment. If we do confirm that active inflammation is present, then we would switch to a different mechanism of action, either a novel biologic, or one of our newly approved small molecules. Now, when I talk about strategies, that's a reactive strategy, which most people will agree upon with the anti-TNFs. We also talk a little bit about proactive drug monitoring, which I am a big proponent of. Just for full transparency, proactive drug monitoring is like Democrats and Republicans fighting over the rationale whether it should be done or not.

I review the available evidence, and hopefully I convince people that proactive drug monitoring is not the way to go for every patient, but is an alternative to combination therapy with an anti-TNF and an immune suppressant in our patients with IBD. During the whole talk, we really used real case examples from my practice to show how I implement this in clinical practice. So, in the future, I hope you're able to attend one of our Regional Advances in IBD or the national course, where you can learn more about therapeutic drug monitoring, and I thank you very much for your attention.