Rationale for #TDM
All TDM should be performed in the context of the clinical disease activity and severity -@IBDMD
All TDM should be performed in the context of the clinical disease activity and severity -@IBDMD
Philosophy of #TDM
Drug assays ⬇️⬇️⬇️
Phase 1⃣
Genetic polymorphisms for thiopurines and anti-TNFs
Combo therapy with anti-TNF > monotherapy, *but* it's not always necessary
Phase 2⃣ of #TDM
Who has ⬆️ clearance of anti-TNFs?
We can stratify likelihood of loss of response!
We can stratify likelihood of loss of response!
⬆️ level is associated with ⬆️ response
Proactive #TDM > reactive TDM? Still up for debate...?
Phase 3⃣ of #TDM
Is the patient losing response to therapy?
Reactive #TDM targets
The most informative level is 0.
>10 means drug is present, but there may not be enough.
The most informative level is 0.
>10 means drug is present, but there may not be enough.
For anti-TNF only.
NOT helpful if no detectable drug.
Rememvber to follow up
NOT helpful if no detectable drug.
Rememvber to follow up
#TDM can detect subclinical loss of response in the asymptomatic patient
Phase 4⃣ of #TDM
We *can* restart medications after drug holiday! Use #TDM to guide.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
