Biologic concentration testing in inflammatory bowel disease

Byron P. Vaughn, William J. Sandborn, Adam S. Cheifetz

Research output: Contribution to journalReview articlepeer-review

53 Scopus citations


Anti-TNF medications have revolutionized the care of patients with inflammatory bowel disease. However, despite an initial robust effect, loss of response is common and long-term results are disappointing. Much of this lack of durability may be due to inadequate dose optimization, and recent studies suggest a correlation between serum drug concentrations and clinical outcomes. Currently, in clinical practice, measurement of drug concentrations and antibodies to drug are typically performed only when a patient presents with active inflammatory bowel disease symptoms or during a potential immune-mediated reaction to anti-TNF ("reactive" setting). However, proactive monitoring of anti-TNF concentrations with titration to a therapeutic window (i.e., therapeutic concentration monitoring) represents a new strategy with many potential clinical benefits including prevention of immunogenicity, less need for IFX rescue therapy, and greater durability of IFX treatment. This review will cover the salient features of anti-TNF pharmacokinetics and pharmacodynamics and provide a rational approach for the use of anti-TNF concentration testing in both the reactive and proactive settings.

Original languageEnglish (US)
Pages (from-to)1435-1442
Number of pages8
JournalInflammatory bowel diseases
Issue number6
StatePublished - Apr 3 2015

Bibliographical note

Publisher Copyright:
© 2015 Crohn's and Colitis Foundation of America, Inc.


  • Anti-TNF
  • Crohn's disease
  • adalimumab
  • inflammatory bowel disease
  • infliximab
  • loss of response
  • pharmacodynamics
  • pharmacokinetics
  • therapeutic concentration monitoring
  • ulcerative colitis


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