Abstract
BackgroundEvidence supports therapeutic drug monitoring (TDM) in improving efficacy and cost-effectiveness of anti-TNF therapy in inflammatory bowel disease (IBD). Data on perceptions and barriers to TDM use are limited and no data are available from India. Our objective was to assess clinicians’ attitudes and barriers to TDM use in IBD.MethodsA 16-question survey was distributed to members of the Indian Society of Gastroenterology. Information on clinician characteristics, demographics, use and barriers towards TDM with anti-TNFs was collected. Logistic regression was used to predict factors influencing TDM use.ResultsTwo hundred and forty-two respondents participated (92.5% male); 83% were consultant gastroenterologists. Of 104 respondents meeting inclusion criteria (treating > 5 IBD patients and at least 1 with an anti-TNF per month), complete responses were available for 101 participants. TDM was utilized by 20% (n = 20) of respondents. Of them, 89.5% (n = 17) used TDM for secondary loss of response; 73.7% (n = 14) for primary non-response and 5.3% (n = 1) proactively. Barriers to TDM use were cost (71.2%), availability (67.8%), time lag in results (58.7%) and the perception that TDM is time-consuming (45.7%). Clinicians treating > 30 IBD patients were more likely to check TDM (OR = 4.9, p = 0.02). Of 81 respondents not using TDM, 97.5% (n = 79) would do so if all the barriers were removed.ConclusionSignificant barriers to TDM use were availability, cost and time lag for results. If these barriers were removed, almost all the clinicians would use TDM at least reactively and 25% would use proactively. There is an urgent need to address these barriers and optimize anti-TNF therapy for optimal outcomes.
Highlights
Anti-TNF therapies have transformed the care of patients with inflammatory bowel disease (IBD)
Up to 30% of patients have a primary non-response (PNR) and up to 50% will develop a secondary loss of response (SLR) to anti-TNFs [7, 8]
Responses were received from 242 participants, of whom 104 met inclusion criteria (138 clinicians reported treating less than 5 IBD patients per month and/or having no patient on anti-TNF therapy and were excluded)
Summary
Anti-TNF therapies have transformed the care of patients with inflammatory bowel disease (IBD). They have re-defined our perceptions around meaningful disease control - moving beyond symptom control to bolder definitions such as mucosal healing, histological and deep remission and an improvement in quality of life [1, 2]. Up to 30% of patients have a primary non-response (PNR) and up to 50% will develop a secondary loss of response (SLR) to anti-TNFs [7, 8] This can be caused by low or undetectable drug concentrations due to immune (anti-drug antibodies) and non-immune clearance [7, 9]. Logistic regression was used to predict factors influencing TDM use
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