He provided data on this observation for infliximab, adalimumab, certolizumab and vedolizumab. To date, trough levels have been used predominantly for reactive assessments after loss of response to a biologic medication.
An ongoing debate concerns whether proactive drug monitoring is cost effective and improves outcomes for patients, and if such monitoring should be incorporated into routine clinical practice. Several factors, such as the formation of anti-drug antibodies, concomitant use of other immunosuppressants, baseline level of TNF- α in the serum of patients, hypoalbuminemia and body mass index, can affect the pharmacokinetics of monoclonal antibodies. Dr. Rubin said all these factors should be considered when evaluating efficacy and the potential for loss of electiveness of biologics in treating patients with IBD.
Dr. Rubin ended his talk by imploring the audience to be cognizant of warning signs of IBD, such as changes in bowel habits, blood in the stool, nocturnal symptoms and unintentional weight loss. Additionally, anemia and low levels of vitamin B12, vitamin D and albumin may all be indicators of IBD.
Only through astute, thorough clinical evaluation and by working together to identify and treat IBD and its myriad manifestations will rheumatologists and gastroenterologists be able to help patients.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
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