What to know about the AGA's 5 new therapeutic drug monitoring recommendations for IBD

The American Gastroenterological Association issued five recommendations for therapeutic drug monitoring for inflammatory bowel disease, MPR reports.

The AGA developed these adult guidelines to "inform appropriate utilization of TDM with anti-tumor necrosis factor TNF-α agents and thiopurines." The guidelines also define the role testing takes for genetic or enzymatic activity of thiopurine methyltransferase prior to thiopurine therapy.

The guidelines do not include monitoring recommendation for either vedolizumab or ustekinumab.

Here's what you should know:

1. For adults treated with anti-TNF agents, the AGA suggests using reactive therapeutic drug monitoring to develop a treatment plan. The recommendation is conditional and based on a very low quality of evidence.

The AGA recommends specific doses for the following agents:

  • Infliximab: ≥5 μg/mL
  • Adalimumab: ≥7.5 μg/mL
  • Certolizumab pegol: ≥20 μg/mL
  • Golimumab: unknown

2. For patients with quiescent IBD treated with anti-TNF agents, the AGA makes no recommendation on the use of routine drug monitoring. The AGA cited a lack of data.

3. In patients receiving thiopurines, the AGA suggests routine thiopurine methyltransferase testing in advance of thiopurine dosing. The recommendation is conditional on a low quality of evidence.

4. In patients treated with thiopurines with IBD or adverse effects possibly related to thiopurine toxicity, the AGA suggests thiopurine metabolite monitoring to guide any possible treatment changes. This is a conditional recommendation based on a very low quality of evidence.

The panel suggests using a target 6-thioguanine cutoff between 30 and 450 pmol/8x10^8 red blood cells, if used as a monotherapy.

5. In patients with quiescent IBD treated by thiopurines, the AGA suggests against using routine thiopurine metabolite monitoring. This is a conditional recommendation based on a very low quality of evidence.

For the recommendations, click here.

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