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Abstract：
Therapeutic drug monitoring (TDM) is the measurement of drug and antidrug antibody concentrations in individuals to guide treatment decisions. In patients with Crohn disease (CD), TDM, used either reactively or proactively, is emerging as a valuable tool for optimization of tumor necrosis factor (TNF) antagonist therapy. Reactive TDM is carried out in response to treatment failure, whereas proactive TDM involves the periodic monitoring of patients responding to TNF antagonist therapy to allow treatment optimization. In patients with CD, most of the available data for TDM relate to the first-to-market TNF antagonist infliximab and, to a lesser extent, to adalimumab and certolizumab pegol. Several gastroenterology associations, including the American Gastroenterology Association, have endorsed the use of reactive TDM in patients with active CD. However, fewer recommendations currently exist for the use of proactive TDM, although several new prospective randomized controlled trials evaluating proactive TDM strategies have been published. In this review, the current evidence for reactive and proactive TDM is discussed, and a proactive treatment algorithm for certolizumab pegol based on previously published threshold concentrations is proposed.
摘要：
治疗药物监测(TDM)是测量个体中的药物和抗药物抗体浓度以指导治疗决策。在克罗恩病（CD）患者中，TDM,反应性或主动使用，正在成为优化肿瘤坏死因子（TNF）拮抗剂治疗的有价值的工具。反应性TDM是针对治疗失败而进行的，而主动TDM涉及对TNF拮抗剂治疗的患者的定期监测,以优化治疗.在CD患者中，TDM的大多数可用数据与首次上市的TNF拮抗剂英夫利昔单抗有关，在较小程度上，阿达木单抗和塞妥珠单抗。几个胃肠病学协会，包括美国胃肠病学协会,已批准在活动性CD患者中使用反应性TDM。然而,目前使用主动TDM的建议较少，尽管已经发表了几项新的评估前瞻性TDM策略的前瞻性随机对照试验.在这次审查中,讨论了反应性和主动性TDM的当前证据，并提出了一种基于先前发表的阈值浓度的塞托珠单抗pegol的主动治疗算法。
