Optimising treatment (TDM)
Optimising treatment (Biomarkers)
Therapeutic Drug Monitoring (TDM) and biomarkers such as faecal calprotection (FC) can be useful tools in helping to support clinical decision making to optimise treatment. Treatment optimisation can involve changing the dosing, infusion interval or stopping treatment.
Please note that Inflectra/infliximab is not licensed for dose escalation in ulcerative colitis, ankylosing spondylitis, psoriasis, psoriatic arthritis, paediatric ulcerative colitis or paediatric Crohn's disease. Inflectra/infliximab is licensed for dose escalation in rheumatoid arthritis and crohn's disease
TDM is a measurement of serum drug concentrations and anti-drug antibodies (ADA) to allow more accurate adjustments of drug levels in an indiviudal patient.1-3
Figure adapted from Tracy D, et al. 2008.
Montioring of infliximab trough levels is associated with improved clinical outcomes during induction therapy and maintenance therapy.5,6 Detectable ADA is associated with decreased serum concentration of infliximab7-9 and understanding ADA status is important to inform clinical decision making in induction and maintenance therapy.7,10,11
Personalised medicine can be particularly effective in infliximab treatment as patients can require different strategies to optimise their therapy.5 A personalised approach using TDM can lead to improved clinical outcomes and more effective use of infliximab, which has potential cost-savings.12-15
Limited therapeutic options are available for patients with IBD16 and maximising anti-TNF drug persistence may help to avoid hospitalisation and surgery.17
Even minimal information can inform treatment strategy . The simple algorithm below can be used to interpret TDM results in clinical practice.18,19
Table created from Khanna R, et a;. 2013 and Bedtzen K, et al. 2019.
+ IS, Immunosuppression
* Please note that Inflectra/infliximab is not licensed for dose escalation in ulcerative colitis, ankylosing spondylitis, psoriasis, psoriatic arthritis, paediatric ulcerative colitis or paediatric Crohn's disease.
Suggested infliximab threshold level for maintenance therapy ranges from >0.5 µg/ml to ≥10.1 µg/ml.20
Learn more about TDM and biomarkers
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