Therapeutic drug monitoring of anti-tumour necrosis factor-α agents in inflammatory bowel disease

Nikola Mitrev, Rupert W. Leong

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Introduction: Anti-TNFα therapy has revolutionised treatment of inflammatory bowel disease, however primary non-response and secondary loss of response are a significant problem. Therapeutic drug monitoring (TDM) has recently emerged as a means of optimising use of anti-TNFα agents. Areas covered: TDM of anti-TNFα agents can guide clinical decisions during treatment failure events, prevent treatment failure events, and potentially result in significant healthcare cost saving. TDM for anti-TNFα agent involves measurement of drug levels and anti-drug antibodies, and can be performed reactively or proactively. Reactive TDM reserves testing for treatment failure events, while proactive TDM also consists of periodic TDM for patients responding to anti-TNFα therapy to allow treatment optimisation. Generation of anti-drug antibodies is recognised as one important mechanism of treatment failure and adverse events. Expert opinion: Evidence strongly supports TDM at time of treatment failure, while studies employing proactive TDM have demonstrated conflicting results. TDM can also help better select patients likely to remain in clinical remission on anti-TNFα treatment interruption. Currently TDM is used to optimise anti-TNFα treatment, but it is not used by most clinicians to prevent adverse reactions to anti-TNFα agents.

Original languageEnglish
Pages (from-to)303-317
Number of pages15
JournalExpert Opinion on Drug Safety
Issue number3
Publication statusPublished - Mar 2017
Externally publishedYes


  • adalimumab
  • anti-drug antibodies
  • anti-tumour necrosis factor-α agents
  • certolizumab
  • Crohn’s disease
  • golimumab
  • inflammatory bowel disease
  • infliximab
  • therapeutic drug monitoring
  • ulcerative colitis


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