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Mitrev N, Vande Casteele N, Seow CH, Andrews JM, Connor SJ, Moore GT, Barclay M, Begun J, Bryant R, Chan W, Corte C, Ghaly S, Lemberg DA, Kariyawasam V, Lewindon P, Martin J, Mountifield R, Radford-Smith G, Slobodian P, Sparrow M, Toong C, van Langenberg D, Ward MG, Leong RW. Review article: consensus statements on therapeutic drug monitoring of anti-tumour necrosis factor therapy in inflammatory bowel diseases. Aliment Pharmacol Ther 2017; 46:1037-1053. [PMID: 29027257 DOI: 10.1111/apt.14368] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/06/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) in inflammatory bowel disease (IBD) patients receiving anti-tumour necrosis factor (TNF) agents can help optimise outcomes. Consensus statements based on current evidence will help the development of treatment guidelines. AIM To develop evidence-based consensus statements for TDM-guided anti-TNF therapy in IBD. METHODS A committee of 25 Australian and international experts was assembled. The initial draft statements were produced following a systematic literature search. A modified Delphi technique was used with 3 iterations. Statements were modified according to anonymous voting and feedback at each iteration. Statements with 80% agreement without or with minor reservation were accepted. RESULTS 22/24 statements met criteria for consensus. For anti-TNF agents, TDM should be performed upon treatment failure, following successful induction, when contemplating a drug holiday and periodically in clinical remission only when results would change management. To achieve clinical remission in luminal IBD, infliximab and adalimumab trough concentrations in the range of 3-8 and 5-12 μg/mL, respectively, were deemed appropriate. The range may differ for different disease phenotypes or treatment endpoints-such as fistulising disease or to achieve mucosal healing. In treatment failure, TDM may identify mechanisms to guide subsequent decision-making. In stable clinical response, TDM-guided dosing may avoid future relapse. Data indicate drug-tolerant anti-drug antibody assays do not offer an advantage over drug-sensitive assays. Further data are required prior to recommending TDM for non-anti-TNF biological agents. CONCLUSION Consensus statements support the role of TDM in optimising anti-TNF agents to treat IBD, especially in situations of treatment failure.
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Costello SP, Ghaly S, Beswick L, Pudipeddi A, Agarwal A, Sechi A, O'Connor S, Connor SJ, Sparrow MP, Bampton P, Walsh AJ, Andrews JM. Compassionate access anti-tumour necrosis factor-α therapy for ulcerative colitis in Australia: the benefits to patients. Intern Med J 2016; 45:659-66. [PMID: 25732268 DOI: 10.1111/imj.12732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/25/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The efficacy of infliximab has been demonstrated in patients with both acute severe and moderate-severe ulcerative colitis (UC). However, there is a need for 'real-life data' to ensure that conclusions from trial settings are applicable in usual care. We therefore examined the national experience of anti-tumour necrosis factor-α (TNF-α) therapy in UC. METHODS Case notes review of patients with UC who had received compassionate access (CA) anti-TNF-α therapy from prospectively maintained inflammatory bowel disease databases of six Australian adult teaching hospitals. RESULTS Patients either received drug for acute severe UC (ASUC) failing steroids (n = 29) or for medically refractory UC (MRUC) (n = 35). In ASUC, the treating physicians judged that anti-TNF-α therapy was successful in 20/29 patients (69%); in these cases, anti-TNF-α was able to be discontinued (after 1-3 infusions in 19/20 responders) as clinical remission was achieved. Consistent with this perceived benefit, only 7/29 (24%) subsequently underwent colectomy during a median follow up of 12 months (interquartile range (IQR) 5-16). Eight of the 35 patients with MRUC (23%) required colectomy during a median follow up of 28 months (IQR 11-43). The majority of these patients (20/35 or 57%) had anti-TNF-α therapy for ≥4 months, whereas, 27/29 (93%) of ASUC patients had CA for ≤3 months. CONCLUSIONS These data show an excellent overall benefit for anti-TNF-α therapy in both ASUC and MRUC. In particular, only short-duration anti-TNF-α was required in ASUC. These real-life data thus support the clinical trial data and should lead to broader use of this therapy in UC.
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Affiliation(s)
- S P Costello
- Inflammatory Bowel Disease Service, Department of Gastroenterology and School of Medicine, University of Adelaide at Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - S Ghaly
- Department of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - L Beswick
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - A Pudipeddi
- Department of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - A Agarwal
- Inflammatory Bowel Disease Service, Department of Gastroenterology and School of Medicine, University of Adelaide at Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Sechi
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - S O'Connor
- Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - S J Connor
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - M P Sparrow
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - P Bampton
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - A J Walsh
- Department of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - J M Andrews
- Inflammatory Bowel Disease Service, Department of Gastroenterology and School of Medicine, University of Adelaide at Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Andrews JM, Costello SP, Agarwal AK, Bampton P, Beswick L, Connor S, Ghaly S, O'Connor S, Pudipeddi A, Sechi A, Sparrow M, Walsh AJ. Conflict of interest: real and perceived - a more mature consideration is needed. Intern Med J 2016; 46:377-9. [DOI: 10.1111/imj.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J. M. Andrews
- IBD Service, Department of Gastroenterology and Hepatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - S. P. Costello
- IBD Service, Department of Gastroenterology and Hepatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - A. K. Agarwal
- IBD Service, Department of Gastroenterology and Hepatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - P. Bampton
- Department of Gastroenterology; Flinders Medical Centre; Adelaide South Australia Australia
| | - L. Beswick
- Department of Gastroenterology; Barwon Health; Geelong Victoria Australia
| | - S. Connor
- Department of Gastroenterology; Liverpool Hospital; Liverpool New South Wales Australia
| | - S. Ghaly
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - S. O'Connor
- Department of Gastroenterology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - A. Pudipeddi
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - A. Sechi
- IBD Service; Liverpool Hospital; Liverpool New South Wales Australia
| | - M. Sparrow
- Department of Gastroenterology; Alfred Hospital; Melbourne Victoria Australia
| | - A. J. Walsh
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
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Mazzola C, Berookhim B, Ghaly S, O’brien K, Müller A, Mulhall J. Le profil hormonal sérique comme prédicteur du score au questionnaire « Androgen Deficiency in the Aging Male » (ADAM). Prog Urol 2015; 25:813. [DOI: 10.1016/j.purol.2015.08.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ghaly S, Costello S, Beswick L, Pudipeddi A, Agarwal A, Sechi A, Antoniades S, Headon B, Connor S, Lawrance IC, Sparrow M, Walsh AJ, Andrews JM. Dose tailoring of anti-tumour necrosis factor-alpha therapy delivers useful clinical efficacy in Crohn disease patients experiencing loss of response. Intern Med J 2015; 45:170-7. [DOI: 10.1111/imj.12621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/02/2014] [Indexed: 12/22/2022]
Affiliation(s)
- S. Ghaly
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
- Centre for Inflammatory Bowel Disease; Fremantle Hospital; Fremantle Western Australia Australia
| | - S. Costello
- IBD Service; Department of Gastroenterology and Hepatology; School of Medicine; University of Adelaide at Royal Adelaide Hospital; Adelaide South Australia Australia
| | - L. Beswick
- Department of Gastroenterology; The Alfred Hospital; Melbourne Victoria Australia
| | - A. Pudipeddi
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - A. Agarwal
- IBD Service; Department of Gastroenterology and Hepatology; School of Medicine; University of Adelaide at Royal Adelaide Hospital; Adelaide South Australia Australia
| | - A. Sechi
- Department of Gastroenterology; Liverpool Hospital; University of NSW; Sydney New South Wales Australia
| | - S. Antoniades
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - B. Headon
- Department of Gastroenterology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Connor
- Department of Gastroenterology; Liverpool Hospital; University of NSW; Sydney New South Wales Australia
| | - I. C. Lawrance
- Centre for Inflammatory Bowel Disease; Fremantle Hospital; Fremantle Western Australia Australia
| | - M. Sparrow
- Department of Gastroenterology; The Alfred Hospital; Melbourne Victoria Australia
| | - A. J. Walsh
- Department of Gastroenterology; St Vincent's Hospital; Sydney New South Wales Australia
| | - J. M. Andrews
- IBD Service; Department of Gastroenterology and Hepatology; School of Medicine; University of Adelaide at Royal Adelaide Hospital; Adelaide South Australia Australia
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Mazzola C, Berookhim B, Ghaly S, O'Brien K, Mueller A, Mulhall J. Serum hormone profiles as predictors of androgen deficiency in the aging male (ADAM) questionnaire scores. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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