American Gastroenterological Association Institute Guideline on Therapeutic Drug Monitoring in Inflammatory Bowel Disease

These practice guideline recommendations for TDM in IBD were developed using the GRADE framework and in adherence with the standards for guideline development set forth by the Institute of Medicine for the creation of trustworthy guidelines.6Graham R. Mancher M. Wolman D.M. et al.Clinical Practice Guidelines We Can Trust. National Academies Press, Washinton, DC2011Crossref Google Scholar, 7Sultan S. Falck-Ytter Y. Inadomi J.M. The AGA institute process for developing clinical practice guidelines part one: grading the evidence.Clin Gastroenterol Hepatol. 2013; 11: 329-332Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar The current evidence supports the use of reactive TDM to guide treatment changes in patients with active IBD who are being treated with anti-TNF agents or thiopurines. However, there is insufficient evidence to inform on the use of routine proactive TDM with anti-TNF agents in patients with quiescent disease. For thiopurines, routine proactive thiopurine metabolite monitoring is not recommended in patients with quiescent IBD. Current evidence supports testing for TPMT enzyme or genotype before initiation of a thiopurine. However, this is not a replacement for routine laboratory monitoring with CBC and liver enzymes after starting therapy with a thiopurine. To further provide guidance on how to implement this guideline in practice, a clinical decision support tool on when to perform TDM and how to interpret TDM when patients are taking an anti-TNF agent or a thiopurine has been provided.33American Gastroenterological AssociationTherapeutic drug monitoring in inflammatory bowel disease––clinical decision support tool.Gastroenterology. 2017; 153: 858-859Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar