Precision Dosing of Anti-TNF Therapy in Pediatric Inflammatory Bowel Disease.

Q1 Medicine Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-09-11 DOI:10.1007/s11894-023-00895-4

Abigail Samuels, Kaitlin G Whaley, Phillip Minar

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Abstract

Purpose of the review: This review focuses on recent advancements in anti-TNF therapeutic drug monitoring (TDM), pharmacogenetics and personalized drug selection for children with inflammatory bowel disease (IBD).

Recent findings: Several real-world studies and one clinical trial in children have demonstrated that proactive TDM, targeting higher exposure concentrations (> 5 µg/mL), can improve disease remission rates and enhance durability of the anti-TNF biologics. Recent data from both adult and pediatric IBD patients have revealed an association between a genetic polymorphism (HLA-DQA1*05) and the development of auto-drug antibodies. The impact of this association on clinical outcomes, considering more routine use proactive TDM and dose optimization in children, is still under investigation. Additionally, recent studies have identified potential inflammatory signatures and biomarkers that may serve as companion diagnostics for anti-TNF biologics. The effective management of anti-TNF therapies in children with IBD requires evidence-based precision dosing strategies, including routine TDM and proactive pharmacodynamic assessments.

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抗肿瘤坏死因子治疗在儿童炎症性肠病中的精确剂量

综述目的:本文综述了抗肿瘤坏死因子治疗药物监测(TDM)、药物遗传学和炎症性肠病(IBD)儿童个性化药物选择的最新进展。最近的发现:一些真实世界的研究和一项儿童临床试验表明，针对更高暴露浓度(bbb50µg/mL)的主动TDM可以提高疾病缓解率并增强抗tnf生物制剂的耐久性。最近来自成人和儿童IBD患者的数据显示，遗传多态性(HLA-DQA1*05)与自身药物抗体的产生之间存在关联。考虑到在儿童中更常规地使用主动TDM和剂量优化，这种关联对临床结果的影响仍在调查中。此外，最近的研究已经确定了潜在的炎症特征和生物标志物，可以作为抗tnf生物制剂的伴随诊断。IBD患儿抗tnf治疗的有效管理需要基于证据的精确给药策略，包括常规TDM和主动药效学评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Gastroenterology Reports Medicine-Gastroenterology

CiteScore

7.80

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0.00%

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期刊介绍： As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.

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