Therapeutic drug monitoring in inflammatory bowel disease: for every patient and every drug?
Purpose of review The current review provides an updated overview on the role of therapeutic drug monitoring (TDM) of biological therapies in inflammatory bowel disease (IBD). We examine the data behind TDM for the antitumor necrosis factor agents, vedolizumab and ustekinumab, in patients with IBD. In addition, we discuss reactive vs. proactive TDM. Recent findings There is a positive correlation between biologic drug concentrations and favorable therapeutic outcomes in IBD, although the majority of data refer to antitumor necrosis factor therapy. Reactive TDM has rationalized the management of patients with IBD with loss of response to biological therapy. Moreover, reactive TDM of infliximab has been proven to be more cost-effective when compared with empiric dose optimization. Preliminary data suggest that proactive TDM of infliximab and adalimumab applied in patients with clinical response/remission is associated with better therapeutic outcomes compared with standard of care (empiric treatment and/or reactive TDM). Summary For all biologics in IBD, there is a positive correlation between drug concentrations and favorable therapeutic outcomes. Reactive TDM is the new standard of care for optimizing biologic therapies in IBD, whereas recent data suggest an important role of proactive TDM for optimizing antitumor necrosis factor therapy in IBD.
The Crohn’s-like lymphoid reaction (CLR) to colorectal cancer (CRC), a CRC-specific ectopic lymphoid reaction, is thought to play an important role in the host response to CRC. CLR is characterized by peritumoral lymphocytic aggregates that are found at the advancing edge of the tumor. Spatial and molecular characterization of CLR within the tumor microenvironment (TME) have uncovered a spectrum of peritumoral lymphoid aggregates with varying levels of organization and maturation. In early stages of CLR development, CD4+ T-cells cluster predominantly with mature antigen presenting dendritic cells. As CLR matures, inc...
We report a case of a 46-year-old Chinese male who presented with six months history of abdominal pain, weight loss and rectal bleeding. Diagnostic colonoscopy revealed multiple aphthous ulcers within the ileo-caecal region and distal transverse colon, separated by normal mucosa, mimicking skip lesions of Crohn's colitis. Computer topography (CT) scan of the abdomen showed multiple circumferential thickenings involving predominantly the right colon. A clinical diagnosis of colonic Crohn's disease with possible perforation was made. An extended right hemicolectomy was performed due to uncontrolled rectal bleeding. Histopath...
Introduction: Inflammatory bowel disease (IBD) and hidradenitis suppurativa (HS) are both chronic inflammatory diseases with a big impact in the quality of life of the patients. It has been described a higher prevalence of HS among patients diagnosed with IBD, especially Crohn disease. Some drugs used in HS, such as antibiotics, can be harmful for IBD patients and they may trigger flare ups. Adalimumab is anti-TNF drug which is approved for the treatment of both diseases, being the doses similar in both disorders.
Background: The pathogenesis of psoriasis may involve a breakdown of immune tolerance to cutaneous microorganisms. Guttate and chronic plaque psoriasis are associated with Streptococcus pyogenes colonization. In addition, Crohn disease and periodontitis, two diseases due to immune activation in response to microbiota, have been reported at a higher incidence in patients with psoriasis.
Pyoderma gangrenosum (PG) is a sterile, idiopathic, ulcerative, neutrophilic dermatosis that can be associated with trauma or systemic diseases. The lesion typically begins as a pustule that later progresses to an ulcer or deep erosion with violaceous undermined borders. Diagnosis of PG is based on histopathology as well as exclusion of other diagnoses. Approximately 50% of PG cases are associated with systemic diseases, which include inflammatory bowel disease (IBD), rheumatoid arthritis, and hematologic malignancies.
Study objectives: Many patients with psoriasis (PSO) experience comorbidities such as psoriatic arthritis, cardiovascular disease, inflammatory bowel disease and depression, which can make treatment and management challenging. We assessed whether an online, virtual patient simulation (VPS) activity could improve the competence of dermatologists in managing patients with PSO and comorbidities.
The objective of this study is to describe the epidemiological trend of PG patients in a university-based wound care outpatient center, focusing on demographics, comorbidities, and treatments.
We present a 24 year old female with a 4 year history of hidradenitis suppurativa (HS) and nodulocystic acne who developed vitiligo 4 mon ths after commencing adalimumab. Anti TNF therapy has been successfully used in other diseases, where the development of vitiligo has been noted in case reports.
Introduction: Paradoxical psoriasiform reactions due to the use of anti-TNF form a clinical spectrum that requires a correct multidisciplinary approach. This is due to the fact that they often cause great functional impotence, especially palmoplantar pustulosis or severe forms of the scalp, being refractory to the treatments classically used. Ustekinumab, following its recent approval for the treatment of inflammatory bowel disease (IBD), may be a good therapeutic alternative for these patients.