Therapeutic drug monitoring for de-escalating anti-tumor necrosis factor therapy in patients with inflammatory bowel disease.

Abstract

Introduction: Cumulative evidence suggests that proactive therapeutic drug monitoring (TDM) of anti-tumor necrosis factor (anti-TNF) therapy is associated with favorable outcomes in inflammatory bowel disease (IBD). However, there is limited information regarding the role of proactive TDM for de-escalating anti-TNF therapy in IBD.

Areas covered: This narrative review will provide an overview of the role of proactive TDM for anti-TNF therapy de-escalation in IBD. A literature search was performed using PubMed between 2005 and June 2025.

Expert opinion: Cumulative evidence suggests that proactive TDM plays a key role in guiding anti-TNF therapy de-escalation, as in patients with supra-therapeutic drug concentrations and discontinuation of the IMM in case of combination therapy with infliximab, as in patients with high drug concentrations prior to IMM withdrawal. Moreover, preliminary data suggest that proactive TDM may also help guiding anti-TNF therapy withdrawal, as in patients with sustained remission and undetectable or low drug concentrations at the time of drug discontinuation. Finally, proactive TDM is also important for surveillance of patients after treatment de-escalation to prevent low drug concentrations and immunogenicity. However, there are still some knowledge gaps including the ideal drug concentration before treatment de-escalation and if drug clearance rather than concentration can better guide anti-TNF therapy de-escalation.