New Frontiers in Therapeutic Drug Monitoring of Biologics in Inflammatory Bowel Disease and Other Immune-Mediated Inflammatory Diseases

Dear Colleagues,

Biologics have revolutionized the treatment of inflammatory bowel disease (IBD) and other immune mediated inflammatory diseases (IMID), such as rheumatoid arthritis, ankylosing spondylitis, and psoriasis. Nevertheless, some patients show no clinical benefit following induction, and others see a diminished response over time. Both these unwanted outcomes are mostly attributed to inadequate drug concentrations and often the development of antidrug antibodies. Reactive therapeutic drug monitoring (TDM) has rationalized the management of lack or loss of response and is more cost-effective than empirical treatment optimization based only on symptoms. Recent data suggest that proactive TDM and dosing to a therapeutic drug concentration in patients in clinical remission is associated with improved long-term outcomes. However, before a wide implementation of TDM in real life clinical practice, several barriers need to be overcome, one of the most important being the optimal drug concentrations to target that can be outcome-, assay-, and even patient-specific. Other knowledge gaps include the role of peak drug concentrations, stool or tissue drug concentrations, total drug exposure, TDM during induction therapy, and TDM for biologics other than anti-TNFs. Future perspectives regarding the role of TDM include the use of rapid point-of-care assays as well as the incorporation of pharmacokinetic modeling and pharmacogenetics towards individual personalized medicine. The aim of this Special Issue is to highlight recent advances in the use of TDM in IBD and other IMID.

Dr. Konstantinos Papamichael
Guest Editor

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