PDF(Pubmed)
Abstract：
Background: Inflammatory bowel disease (IBD), encompassing ulcerative colitis and Crohn\'s disease, necessitates long-term medical therapy to manage symptoms and prevent complications. Therapeutic drug monitoring (TDM) has emerged as a strategy to optimize treatment efficacy, particularly with anti-tumour necrosis factor (anti-TNF) alpha drugs. This review explores the role of TDM for non-anti-TNF advanced therapies in IBD, focusing on vedolizumab, ustekinumab, tofacitinib, upadacitinib, risankizumab and ozanimod. Methods: The literature search, conducted through OVID (Medline) and PubMed, delves into proactive versus reactive TDM, timing of monitoring and methods for measuring drug levels and anti-drug antibodies. Results: While ustekinumab and vedolizumab exhibit exposure-response relationships, consensus on target levels and the role of TDM adjustments remains elusive. Limited data on risankizumab suggest a dose-dependent response, while for small molecule therapies (janus kinase inhibitors and ozanimod), the absence of real-world data and commercially available TDM tools pose challenges. Conclusion: At present, with the available data, there is a limited role for TDM in non-anti-TNF biologic and small-molecule therapies. This review underscores the need for further research to delineate the utility of TDM in guiding treatment decisions for these agents.
摘要：
背景：炎症性肠病（IBD），包括溃疡性结肠炎和克罗恩病，需要长期的药物治疗来控制症状和预防并发症。治疗药物监测（TDM）已成为优化治疗效果的策略，特别是抗肿瘤坏死因子（抗TNF）α药物。本文就TDM在非TNF-α治疗IBD中的作用作一综述。专注于维多珠单抗，ustekinumab,托法替尼,upadacitinib,risankizumab和ozanimod.方法:文献检索,通过OVID(Medline)和PubMed进行，深入研究主动TDM与被动TDM，监测时间和测量药物水平和抗药物抗体的方法。结果：虽然ustekinumab和vedolizumab表现出暴露-反应关系，关于目标水平和TDM调整的作用的共识仍然难以捉摸。关于risankizumab的有限数据表明存在剂量依赖性反应，而对于小分子疗法（Janus激酶抑制剂和ozanimod），缺乏现实世界的数据和商业上可用的TDM工具带来了挑战。结论:目前,有了可用的数据，TDM在非抗TNF生物和小分子治疗中的作用有限.这篇综述强调了需要进一步研究来描述TDM在指导这些药物的治疗决策中的实用性。
