Proactive monitoring of infliximab during maintenance therapy may increase sustained disease control in patients with inflammatory bowel disease and arthritis, potentially adding 146 more patients per 1,000 to annual remission rates, according to a recent systematic review and meta-analysis.
In the study, published in BMJ Medicine, investigators evaluated the efficacy of proactive therapeutic drug monitoring (TDM) in patients receiving biologics, particularly infliximab and adalimumab, for inflammatory bowel disease (IBD), inflammatory arthritis, and psoriasis. This analysis included 10 randomized controlled trials comprising 2,383 patients and assessed whether TDM during induction or maintenance therapy improved clinical outcomes such as sustained disease control or remission.
The findings indicated that during maintenance therapy with infliximab, proactive TDM may increase the likelihood of sustained disease control or remission. Across five trials (982 patients), proactive TDM was associated with a 26% relative increase in sustained disease control compared with standard care (relative risk = 1.26, 95% confidence interval [CI] = 1.14–1.40), corresponding to 146 more patients per 1,000 achieving sustained control annually (95% CI = 78–224). However, evidence supporting the benefit of TDM during infliximab induction was low and inconclusive. For maintenance therapy with adalimumab, the effects of proactive TDM were similarly uncertain, with evidence providing no strong support for its effectiveness.
Notably, proactive TDM in infliximab maintenance therapy may mitigate disease worsening without significantly altering quality of life, physical function, or mental health outcomes. The analysis also found insufficient data regarding proactive TDM’s impact on the formation of antidrug antibodies and the occurrence of adverse events, and limited generalizability across different biologic agents.
Proactive TDM of infliximab during maintenance may aid in maintaining disease control among patients with immune-mediated inflammatory conditions in clinical settings. However, given the current low-certainty evidence for TDM during induction and with adalimumab, further investigation is warranted to clarify TDM's clinical benefits across biologic therapies and patient populations, particularly in diseases with high immunogenic profiles such as IBD.
Full disclosures can be found in the published review.