2017-08-29 13:25:41 UTC

AGA Releases New Evidence-Based Clinical Guideline on Therapeutic Drug Monitoring in IBD

Aug. 30, 2017

Reactive therapeutic drug monitoring can guide treatment in IBD patients.

AGA has issued a new clinical guideline on the role of therapeutic drug monitoring (TDM) in the management of IBD, published in Gastroenterology. The guideline focuses on the application of TDM for biologic therapy, specifically anti-tumor necrosis factor-α (TNF) agents, and for thiopurines, and addresses questions on the risks and benefits of reactive TDM, routine proactive TDM or no TDM in guiding treatment changes. AGA’s recommendations include: 

Statement Strength of Recommendation Quality of Evidence
In adults with active IBD treated with anti-TNF agents, AGA suggests reactive TDM to guide treatment changes.  Conditional recommendation Very low quality
In adult patients with quiescent IBD treated with anti-TNF agents, AGA makes no recommendation regarding the use of routine proactive TDM. No recommendation Knowledge gap
In adult patients with IBD being started on thiopurines, AGA suggests routine TPMT testing (enzymatic activity or genotype) to guide thiopurine dosing. Conditional recommendation Low quality
In adult patients treated with thiopurines with active IBD or adverse effects thought to be due to thiopurine toxicity, AGA suggests reactive thiopurine metabolite monitoring to guide treatment changes. Conditional recommendation Very low quality
In adult patients with quiescent IBD treated with thiopurines, AGA suggests against routine thiopurine metabolite monitoring. Conditional recommendation Very low quality
























The guideline is accompanied by a technical review, Clinical Decision Support Tool and patient companion, which provides key points and important information directly to patients about this approach, written at an appropriate reading level. Access the patient companion in the Patient Info Center

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