Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Journal of Clinical Medicine

Silvio Danese¹  Laurent Peyrin-Biroulet²  Natalia Sousa Freitas Queiroz³  Konstantinos Papamichael⁴  Adam S. Cheifetz⁴  Phillip R. Fleshner⁵  Antonino Spinelli⁶  Paulo Gustavo Kotze⁷  Rodrigo Bremer Nones⁷ 

[1] Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy;Department of Gastroenterology, University Hospital of Nancy, 54500 Nancy, France;Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-000, Brazil;Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;Health Sciences Postgraduate Program, School of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba 80215-901, Brazil;

关键词: therapeutic drug monitoring;    inflammatory bowel disease;    surgery;    Crohn’s disease;    ulcerative colitis;    anti-TNF therapy;   

DOI  :  10.3390/jcm10235642

来源: DOAJ

【 摘 要 】

Despite significant development in the pharmacological treatment of inflammatory bowel diseases (IBD) along with the evolution of therapeutic targets and treatment strategies, a significant subset of patients still requires surgery during the course of the disease. As IBD patients are frequently exposed to biologics at the time of abdominal and perianal surgery, it is crucial to identify any potential impact of biological agents in the perioperative period. Even though detectable serum concentrations of biologics do not seem to increase postoperative complications after abdominal procedures in IBD, there is increasing evidence on the role of therapeutic drug monitoring (TDM) in the perioperative setting. This review aims to provide a comprehensive summary of published studies reporting the association of drug concentrations and postoperative outcomes, postoperative recurrence (POR) after an ileocolonic resection for Crohn’s disease (CD), colectomy rates in ulcerative colitis (UC), and perianal fistulizing CD outcomes in patients treated with biologics. Current data suggest that serum concentrations of biologics are not associated with an increased risk in postoperative complications following abdominal procedures in IBD. Moreover, higher concentrations of anti-TNF agents are associated with a reduction in colectomy rates in UC. Finally, higher serum drug concentrations are associated with reduced rates of POR after ileocolonic resections and increased rates of perianal fistula healing in CD. TDM is being increasingly used to guide clinical decision making with favorable outcomes in many clinical scenarios. However, given the lack of high quality data deriving mostly from retrospective studies, the evidence supporting the systematic application of TDM in the perioperative setting is still inconclusive.

【 授权许可】

Unknown