{"id":6358,"date":"2019-09-30T22:02:52","date_gmt":"2019-09-30T20:02:52","guid":{"rendered":"https:\/\/www.endoscopy-campus.com\/ec-news\/therapeutic-drug-monitoring-of-vedolizumab-should-trough-levels-be-measuredand-when\/"},"modified":"2019-09-30T22:28:14","modified_gmt":"2019-09-30T20:28:14","slug":"therapeutic-drug-monitoring-of-vedolizumab-should-trough-levels-be-measuredand-when","status":"publish","type":"ec-news","link":"https:\/\/www.endoscopy-campus.com\/en\/ec-news\/therapeutic-drug-monitoring-of-vedolizumab-should-trough-levels-be-measuredand-when\/","title":{"rendered":"Therapeutic Drug Monitoring of Vedolizumab: Should Trough Levels Be Measured\u2026and When?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">In IBD patients treated with anti-TNF agents, therapeutic drug monitoring (TDM) is commonly used to optimize therapy, reduce risk of antibody formation, and determine mechanisms for primary or secondary nonresponse. The utility of TDM for vedolizumab has not been established. The authors performed a systematic review of cohort studies that reported associations between vedolizumab troughs and clinical outcomes during induction or maintenance therapy.<\/p>\n\n<p class=\"wp-block-paragraph\">Of 32 studies reviewed, 5 were included in a quantitative analysis to determine median differences in vedolizumab trough levels in patients who did or did not achieve clinical or endoscopic remission during maintenance therapy. Data from the 5 studies were reviewed to assess the relationship between vedolizumab levels and favorable clinical outcomes.<\/p>\n\n<ul class=\"wp-block-list\"><li>Ulcerative colitis induction therapy: Week 6 vedolizumab trough levels &gt;20 \u00b5g\/ml were associated with favorable clinical outcomes.<\/li><li>Ulcerative colitis maintenance therapy: Median trough levels were significantly higher in patients achieving clinical remission (median difference: 5.1 \u00b5g\/ml) and endoscopic remission (median difference: 5.1 \u00b5g\/ml). Maintenance trough levels &gt;12 \u00b5g\/ml were associated with favorable clinical outcomes.\u00a0\u00a0<\/li><li>Crohn\u2019s disease: Meta-analysis found numerically (but not significantly) higher vedolizumab trough levels in patients achieving clinical or endoscopic remission.\u00a0<\/li><li>Vedolizumab antibodies were detected in 1.7% to 3.0% of patients.<\/li><\/ul>\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<figure class=\"wp-block-pullquote\" style=\"border-color:#bd6fb7\"><blockquote><p>Comment:&#13;\nThis analysis suggests a relationship between vedolizumab trough levels and favorable clinical outcomes in ulcerative colitis; however, cause-effect is unproven. Patients with favorable clinical predictors (less inflammation, low C-reactive protein, and high albumin) may have reduced drug clearance\/loss that results in higher drug trough levels.&#13;\nFor patients with primary or secondary loss of response to vedolizumab, the authors suggest TDM, with escalation of drug infusions to every 4 weeks if levels are &lt;20 \u00b5g\/ml at week 6 or &lt;12 \u00b5g\/ml during maintenance.<\/p><\/blockquote><\/figure>\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<div class=\"wp-block-media-text alignwide\" style=\"grid-template-columns:20% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"900\" height=\"951\" src=\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/mcquaid-2017.jpg\" alt=\"\" class=\"wp-image-6356\" srcset=\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/mcquaid-2017.jpg 900w, https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/mcquaid-2017-768x812.jpg 768w\" sizes=\"auto, (max-width: 900px) 100vw, 900px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"has-large-font-size wp-block-paragraph\">Kenneth R. McQuaid, MD, FASGE&#13;\n&#13;\n<\/p>\n<\/div><\/div>\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<h2 class=\"wp-block-heading\"> Citation(s): <\/h2>\n\n<p class=\"wp-block-paragraph\">Singh S, Dulai PS, Vande Casteele N, et al. Systematic review with meta-analysis: association between vedolizumab trough concentration and clinical outcomes in patients with inflammatory bowel diseases.<em>\u00a0Aliment Pharmacol Ther\u00a0<\/em>2019 Sep 4. (Epub ahead of print) (<a href=\"https:\/\/doi.org\/10.1111\/apt.15484\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1111\/apt.15484<\/a>)<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In IBD patients treated with anti-TNF agents, therapeutic drug monitoring (TDM) is commonly used to optimize therapy, reduce risk of antibody formation, and determine mechanisms for primary or secondary nonresponse. The utility of TDM for vedolizumab has not been established. The authors performed a systematic review of cohort studies that reported associations between vedolizumab troughs &#8230; <a title=\"Therapeutic Drug Monitoring of Vedolizumab: Should Trough Levels Be Measured\u2026and When?\" class=\"read-more\" href=\"https:\/\/www.endoscopy-campus.com\/en\/ec-news\/therapeutic-drug-monitoring-of-vedolizumab-should-trough-levels-be-measuredand-when\/\" aria-label=\"Read more about Therapeutic Drug Monitoring of Vedolizumab: Should Trough Levels Be Measured\u2026and When?\">Read more<\/a><\/p>\n","protected":false},"template":"","categories":[1770,1794],"tags":[],"class_list":["post-6358","ec-news","type-ec-news","status-publish","hentry","category-asge-journal-scan-en","category-ibd-en"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news\/6358","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/ec-news"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=6358"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=6358"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=6358"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}