Role of therapeutic drug monitoring of azathioprine and thiopurine methyltransferase enzyme status in patients with inflammatory bowel disease: Indian scenario

Inflammatory bowel disease is mainly caused by dysragulated immune system. Inflammatory bowel disease incidences are rising in Asian countries with difficulty in their diagnosis and managements. There is rising the incidences and prevalence rate in India. Inflammatory bowel disease has two major subtypes Ulcerative colitis and chron’s disease. In ulcerative colitis inflammation occurs in lower part of large intestine that extend from anal verge to proximal colon while in case of chron’s disease there is transmural inflammation of gastrointestinal tract. This review is to provide comprehensive review focused on the current status of therapeutic drug monitoring of azathioprine metabolites in patients of inflammatory bowel disease.

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The cost of treating inflammatory bowel disease: step-up vs step-down, therapeutic drug monitoring and personalised medicine

Gastrointestinal Nursing ◽

10.12968/gasn.2021.19.4.18 ◽

2021 ◽

Vol 19 (4) ◽

pp. 18-24

Author(s):

Pearl Avery

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Therapeutic Drug Monitoring ◽

Bowel Disease ◽

Drug Monitoring ◽

Personalised Medicine ◽

Therapeutic Drug ◽

Patient Reported ◽

Inflammatory Bowel ◽

Step Down

Inflammatory bowel disease (IBD) is a group of lifelong immune-mediated diseases, including Crohn's disease and ulcerative colitis. IBD is traditionally treated with drugs, including 5-aminosalicylates, steroids and immunosuppressants. However, the treatment landscape is changing, owing to a number of factors of significance to the IBD clinical nurse specialist. The recent introduction of novel biologic and biosimilar medications has affected the efficacy and cost of treatment. The established step-up treatment paradigm, where patients are started on simpler, cheaper therapies, is shifting toward a step-down approach, where biologics are the first-line treatment. Meanwhile, nurse-led pro-active therapeutic drug monitoring, including patient-reported outcome measures (PROMs), is helping ensure the efficacy and safety of treatment and allows for adjustments. In the near future, personalised medicine may offer genetic testing to predict a patient's reaction to different drugs and identify the most appropriate therapies. At the author's hospital, some of these factors may have contributed to a 50% reduction in emergency surgical rates for ulcerative colitis. This clinical review examines these issues in light of real-world experience from the author's hospital.

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Current status and future perspectives on the use of therapeutic drug monitoring of thiopurine metabolites in patients with inflammatory bowel disease

Expert Opinion on Drug Metabolism & Toxicology ◽

10.1080/17425255.2021.2029406 ◽

2022 ◽

Author(s):

Debbie S. Deben ◽

Dennis R. Wong ◽

Adriaan A. van Bodegraven

Keyword(s):

Inflammatory Bowel Disease ◽

Therapeutic Drug Monitoring ◽

Bowel Disease ◽

Drug Monitoring ◽

Current Status ◽

Therapeutic Drug ◽

Future Perspectives ◽

Inflammatory Bowel

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Proactive versus Reactive Therapeutic Drug Monitoring: Why, When, and How?

Inflammatory Intestinal Diseases ◽

10.1159/000518755 ◽

2021 ◽

pp. 1-9

Author(s):

Manar Shmais ◽

Miguel Regueiro ◽

Jana G. Hashash

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Therapeutic Drug Monitoring ◽

Bowel Disease ◽

Drug Monitoring ◽

Therapeutic Drug ◽

Loss Of Response ◽

Inflammatory Bowel ◽

Necrosis Factor

Background: Up to a third of inflammatory bowel disease) patients show primary nonresponse to antitumor necrosis factor (anti-TNF) biological therapy, and of those who respond, up to 40% develop secondary loss of response (LOR). Therapeutic drug monitoring (TDM) plays a crucial role in assessing patients with LOR to guide therapy by giving more of the drug or switching to a different biological agent. Although reactive TDM is suggested or recommended by the majority of gastroenterology associations, proactive TDM seems to be more controversial. Summary: In this article, we discuss the updated guidelines on TDM and will also discuss the available data supporting proactive and reactive TDM in patients with Crohn’s disease and those with ulcerative colitis using the different available biological agents. Key Messages: Therapeutic drug monitoring (TDM) is a valuable tool to aid in inflammatory bowel disease (IBD) therapy optimization. Reactive TDM is widely accepted in IBD patients with suspected loss of response, especially in those receiving antitumor necrosis factor (anti-TNF) agents. Proactive TDM is emerging as a reasonable approach to patients initiated on anti-TNF therapy, specifically infliximab and, to some extent, adalimumab, particularly for patients with severe ulcerative colitis and fistulizing Crohn’s disease. Similarly, TDM may play a role in patients considering de-escalation from combination therapy. To date, proactive TDM is not widely applied to ustekinumab and vedolizumab and more data are required before this becomes part of clinical practice.

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