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Therapeutic drug monitoring in inflammatory bowel disease:The dawn of reactive monitoring

World Journal of Gastroenterology 2021年第37期27卷 6231-6247页

作者： Farah Albader Petra Anna Golovics Lorant Gonczi Talat Bessissow Waqqas Afif Peter Laszlo Lakatos Department of Internal Medicine McGill UniversityMontreal H3G1A4QuebecCanada Division of Gastroenterology Hungarian Defence ForcesMedical CentreBudapest H-1062Hungar Division of Gastroenterology McGill UniversityMontreal H3G 1A4QuebecCanada First Department of Medicine Semmelweis UniversityBudapest H-1083Hungary Division of Gastroenterology McGill University Health CentreMontreal H3G 1A4QuebecCanada

Inflammatory bowel disease(IBD)is a chronic condition that significantly affects the quality of life of its *** drugs have been the mainstay treatment in the management of IBD patients but despite their significant contribution,there remains a proportion of patients that do not respond or lose response to *** drug monitoring(TDM)involves measuring levels of serum drug concentrations and anti-drug *** of biologic drugs initially emerged to understand treatment failure in other immune mediated inflammatory *** was then introduced in IBD to rationalize primary non-response or secondary loss of response,given that low serum drug concentrations or the formation of anti-drug antibodies are variably associated with treatment *** aim of this narrative review is to provide an overview regarding the current use of TDM in clinical practice and to present the evidence available regarding its use in both proactive and reactive clinical settings in preventing and managing treatment *** review also presents the existing evidence regarding the association of various clinical outcomes with specific thresholds of drug concentrations,in everyday practice.A narrative review of published articles and conference abstracts regarding the use of TDM in IBD management,through an electronic search using PubMed and *** has proven to be superior and more cost effective in guiding management of patients with treatment failure compared to empiric dose escalation or change in *** a trend towards an association between clinical outcomes and drug concentrations,proactive TDM based strategies have not been shown to achieve clear benefit in long-term *** the clinical setting,TDM has proven to be useful in managing IBD patients,and its use in the reactive setting,as an additional tool to help manage patients with treatment failure,is being promoted as newer guidelines and consensus groups implement

关键词： Therapeutic drug monitoring Inflammatory bowel disease biologic therapies Loss of response Reactive Proactive

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Therapeutic drug monitoring in inflammatory bowel disease treatments

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World Journal of Gastroenterology 2022年第15期28卷 1604-1607页

作者： Meng-Yao Wang Jing-Wen Zhao Chang-Qing Zheng Li-Xuan Sang Department of Gastroenterology Shengjing Hospital of China Medical UniversityShenyang 110022Liaoning ProvinceChina

Recently,biological drugs have played a leading role in the treatment of inflammatory bowel disease,and therapeutic drug monitoring(TDM)may be useful in maximizing their *** involves the measurement of serum drug and anti-drug antibodies concentrations as the basis for dosage adjustments or drug conversions to achieve a higher response *** believe that concentration thresholds should be individualized based on patients’disease severity,extent and phenotype,and therapeutic purposes should also be considered,with higher cut-offs mainly needed for endoscopic and fistula healing than for symptomatic *** and reactive TDM can help optimize treatment,especially in patients receiving anti-tumour necrosis factor,and guide dose adjustment or drug conversion with lower *** is a promising approach to achieve precision medicine and targeted medicine in the future.

关键词： Therapeutic drug monitoring Inflammatory bowel disease biologic therapies Reactive Proactive Cost-effective

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Characteristics, phenotypes, mechanisms and management of severe asthma

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Chinese Medical Journal 2022年第10期135卷 1141-1155页

作者： Kian Fan Chung Piers Dixey Hisham Abubakar-Waziri Pankaj Bhavsari Pujan H.Patel Sujuan Guo Yang Ji National Heart&Lung Institute Imperial College LondonLondon SW36LYUK Royal Brompton&Harefield NHS Hospitals LondonUK Department of Respiratory Medicine University of Hong Kong Shenzhen HospitalShenzhenGuangdong 518053China.

Severe asthma is "asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic corticosteroids) to prevent it from becoming ’’uncontrolled’ or which remains ’’uncontrolled’ despite this therapy." The state of control was defined by symptoms, exacerbations and the degree of airflow obstruction. Therefore, for the diagnosis of severe asthma, it is important to have evidence for a diagnosis of asthma with an assessment of its severity, followed by a review of comorbidities, risk factors, triggers and an assessment of whether treatment is commensurate with severity, whether the prescribed treatments have been adhered to and whether inhaled therapy has been properly administered. Phenotyping of severe asthma has been introduced with the definition of a severe eosinophilic asthma phenotype characterized by recurrent exacerbations despite being on high dose ICS and sometimes oral corticosteroids, with a high blood eosinophil count and a raised level of nitric oxide in exhaled breath. This phenotype has been associated with a Type-2 (T2) inflammatory profile with expression of interleukin (IL)-4, IL-5, and IL-13. Molecular phenotyping has also revealed non-T2 inflammatory phenotypes such as Type-1 or Type-17 driven phenotypes. Antibody treatments targeted at the T2 targets such as anti-IL5, anti-IL5Rα, and anti-IL4Rα antibodies are now available for treating severe eosinophilic asthma, in addition to anti-immunoglobulin E antibody for severe allergic asthma. No targeted treatments are currently available for non-T2 inflammatory phenotypes. Long-term azithromycin and bronchial thermoplasty may be considered. The future lies with molecular phenotyping of the airway inflammatory process to refine asthma endotypes for precision medicine.

关键词： Severe asthma biologic therapies Eosinophils Neutrophils Corticosteroid insensitivity Type 2-high inflammation

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Classical and Emerging therapies against Chronic Obstructive Pulmonary Disease

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Chinese Medical Journal 2018年第16期131卷 1894-1897页

作者： Han-Rong Feng Chao Zhang Song-Min Ying Department of Pharmacology & Department of Respiratory and Critical Care Medicine Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou Zhejiang 310058 China

INTRODUCTION Chronic obstructive pulmonary disease （COPD） is a worldwide respiratory disease which always co-exists with multiple extrapulmonary comorbidities such as cardiovascular diseases and osteoporosis. The World Health Organization pointed out that till 2030, COPD would be the third leading reason of mortality. In spite of the advanced medical research and health-care efforts, COPD still shows continuously increasing quantity of death. Tobacco smoking, indoor and outdoor air pollution （for example, biomass thel）, virus, and pulmonary dysplasia are the main risk factors for COPD. All these factors eventually destroy lung parenchymal tissue and disturb repair and defense system, which eventually lead to emphysema and small airway fibrosis [Figure 1].

关键词： biologic therapies Chronic Obstructive Pulmonary Disease Efficacy and Safety

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