Curr Gastroenterol Rep. 2023 Nov;25(11):323-332.doi: 10.1007/s11894-023-00895-4. Epub 2023 Sep 11.

Abigail Samuels ¹, Kaitlin G Whaley ^2 3, Phillip Minar ^4 5

Author information

¹Department of Medicine, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 5229, USA.

²Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

³Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

⁴Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. phillip.minar@cchmc.org.

⁵Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. phillip.minar@cchmc.org.

Abstract

Purpose of the review: This review focuses on recent advancements in anti-TNF therapeutic drug monitoring (TDM), pharmacogenetics and personalized drug selection for children with inflammatory bowel disease (IBD).

Recent findings: Several real-world studies and one clinical trial in children have demonstrated that proactive TDM, targeting higher exposure concentrations (> 5 µg/mL), can improve disease remission rates and enhance durability of the anti-TNF biologics. Recent data from both adult and pediatric IBD patients have revealed an association between a genetic polymorphism (HLA-DQA1*05) and the development of auto-drug antibodies. The impact of this association on clinical outcomes, considering more routine use proactive TDM and dose optimization in children, is still under investigation. Additionally, recent studies have identified potential inflammatory signatures and biomarkers that may serve as companion diagnostics for anti-TNF biologics. The effective management of anti-TNF therapies in children with IBD requires evidence-based precision dosing strategies, including routine TDM and proactive pharmacodynamic assessments.