Approach to patients with inflammatory bowel disease and loss of response to anti-TNF therapy

This figure summarizes the general approach to drug monitoring for adults who had initially responded to anti-TNF therapy for IBD but who develop loss of response. Anti-TNF agents for maintaining remission in IBD include adalimumab, certolizumab pegol, golimumab, and infliximab. Adalimumab and infliximab are used for treating either Crohn disease or ulcerative colitis, whereas certolizumab pegol is used for treating Crohn disease and golimumab is used for treating ulcerative colitis. Drug monitoring can help inform whether escalating the dose or switching to a different drug is preferred. This algorithm is intended for use in conjunction with other UpToDate content. Refer to the UpToDate topic on dosing and monitoring of anti-TNF agents for additional details.

CRP: C-reactive protein; IBD: inflammatory bowel disease; JAK: Janus kinase; TNF: tumor necrosis factor.

* Examples of other drug classes for IBD include anti-12/23 antibody therapy, anti-integrin therapy, and JAK inhibitor therapy.

¶ Reporting of anti-drug antibodies varies among laboratories and has not been standardized. In general, low antibody levels occur with detectable drug levels, whereas high antibody levels usually occur when drug levels are undetectable.

Δ Immunomodulators that are typically used in combination with anti-TNF agents include azathioprine, 6-mercaptopurine, or methotrexate.

◊ Options for escalating anti-TNF therapy include shortening dosing interval or increasing drug dose.

Graphic 143130 Version 1.0

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Approach to patients with inflammatory bowel disease and loss of response to anti-TNF therapy