Proactive Therapeutic Drug Monitoring in IBD: What’s Stopping You?

Despite the wealth of benefits that can come from the use of proactive therapeutic drug monitoring (TDM) in treating inflammatory bowel disease (IBD), only a few gastroenterologists turn to this approach, according to Adam Cheifetz, MD.

Dr Cheifetz, who is the director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center and associate professor of medicine at Harvard Medical School in Boston, Massachusetts, recently discussed TDM use at the Interdisciplinary Autoimmune Summit (IAS) 2018 in Boston, Massachusetts.

Proactive TDM with drug titration to a target concentration may increase drug durability and decrease IBD-related surgeries and hospitalizations, as well as serious infusion reactions and antibodies to infliximab.¹

However, many physicians are hesitant to put this approach into practice due to a number of potential barriers, even though this approach is commonly used in other medical settings with other medications like tacrolimus and cyclosporine, Dr Cheifetz said.

In a recent study that he co-authored, Dr Cheifetz and colleagues surveyed 403 gastroenterologists from 42 US states to further investigate these barriers to TDM.²

Among this sample of respondents, 90.1% used TDM. However, most respondents used TDM reactively for secondary loss of response (87.1%) and primary nonresponse (66%), whereas only 36.6% used TDM proactively. Even still, these numbers are likely inflated due to selection bias of respondents that chose to fill out the survey.

The greatest barriers to proactive TDM implementation were uncertainty about insurance coverage (77.9%) and high out-of-pocket costs for patients (76.4%), followed by time-lag from serum sample to result (38.5%).

Perhaps most notably, findings indicated that if all barriers were removed, an additional one-third of physicians would apply proactive TDM in the treatment of IBD.

In a Q&A with Consultant360, Dr Cheifetz discussed these findings further and gave insight on potential solutions to the barriers to proactive TDM use. He also shared highlights from his presentation at IAS 2018, “Optimizing the Treatment of IBD through Use of Therapeutic Drug Monitoring.”³

Next: How do barriers affect treatment accessibility?