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Therapeutic drug monitoring in inflammatory bowel disease reduces unnecessary use of infliximab with substantial associated cost-savings

Internal Medicine Journal Oct 12, 2019

Wu Y, Lin B, Thilakanathan C, et al. - Data from all public inflammatory bowel disease (IBD) infliximab (IFX) level testing done across Australia was prospectively obtained from June 2016 to July 2017 in order to ascertain how IFX therapeutic drug monitoring (TDM) was utilized in a real-life clinical setting and to quantify the potential for TDM to diminish the unwanted use of IFX. The most prevalent implication for TDM was the secondary loss of response (reactive TDM). These individuals had consistently lower median IFX levels in comparison with individuals in remission (proactive TDM). With a correlated drug cost saving of $531.38 per IFX TDM test episode, in 30.6% of the TDM tests done in luminal Crohn's disease and ulcerative colitis individuals, TDM aided to recognize undesired use of IFX. In 38.9% (96/247) of reactive IFX TDM tests done and in 19.3% (35/181) of proactive testing, undesirable IFX use was determined. Hence, for IBD management, the use of both reactive and proactive IFX TDM was concluded as cost-efficient as it notifies the clinician where casual use of IFX could be terminated.
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