Therapeutic Drug Monitoring in Inflammatory Bowel Disease
Publication Date: September 1, 2017
Last Updated: December 16, 2022
Treatment
In adults with active IBD treated with anti-TNF agents, AGA suggests reactive therapeutic drug monitoring to guide treatment changes.
Comment: Table 1 summarizes suggested trough concentration for anti-TNF therapy for patients with active IBD on maintenance therapy. Of note, there may be a small subset of patients who may respond to higher target concentrations. Optimal trough concentrations for induction therapy are uncertain.
612
In adult patients with quiescent IBD treated with anti-TNF agents, AGA makes no recommendation regarding the use of routine proactive therapeutic drug monitoring.
612
In adult patients with IBD being started on thiopurines, AGA suggests routine thiopurine methyltransferase (TPMT) testing (enzymatic activity or genotype) to guide thiopurine dosing. (Low, Conditional (weak))
Comment: Routine laboratory monitoring, including CBC, should be performed, regardless of TPMT testing results.
612
In adult patients treated with thiopurines with active IBD or adverse effects thought to be due to thiopurine toxicity, AGA suggests reactive thiopurine metabolite monitoring to guide treatment changes.
Comment: When measuring thiopurine metabolite monitoring in patients with active IBD-related symptoms, we suggest a target 6-thioguanine (6-TGN) cutoff between 230–450 pmol/8 × 108 RBCs when used as monotherapy. Optimal 6-TGN cutoff when thiopurines are used in combination with anti-TNF agents is uncertain.
612
In adult patients with quiescent IBD treated with thiopurines, AGA suggests against routine thiopurine metabolite monitoring.
612
Recommendation Grading
Overview
Title
Therapeutic Drug Monitoring in Inflammatory Bowel Disease
Authoring Organization
American Gastroenterological Association
Publication Month/Year
September 1, 2017
Last Updated Month/Year
March 19, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Target Patient Population
Adults with active IBD
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management
Diseases/Conditions (MeSH)
D015212 - Inflammatory Bowel Diseases, D016903 - Drug Monitoring
Keywords
inflammatory bowel disease, ulcerative colitis, Crohn's disease, IBD, therapeutic drug monitoring