Proposed pathway for therapeutic drug monitoring and dose escalation of vedolizumab
Nassar, Islam Osama Cheesbrough, Jonathan Quraishi, Mohammed Nabil Sharma, Naveen
Nassar, Islam Osama
Cheesbrough, Jonathan
Quraishi, Mohammed Nabil
Sharma, Naveen
Abstract
Vedolizumab is a gut-selective monoclonal antibody approved for the management of Crohn's disease and ulcerative colitis. The available data demonstrate a favourable response to dose escalation in patients with primary non-response or secondary loss of response to vedolizumab. While therapeutic drug monitoring has a proven clinical utility for tumour necrosis factor antagonists, the available guidance for therapeutic drug monitoring and dose escalation of vedolizumab is rather limited. The present review proposes a practical algorithm to use vedolizumab trough levels in the management of treatment failure. Therapeutic drug monitoring can differentiate underexposed patients from those with mechanistic failure. Underdosed patients can respond to dose escalation instead of unnecessarily switching to other treatment modalities. We also review the safety and potential cost-effectiveness of vedolizumab dose escalation, the role of antidrug antibodies and the possible applicability of this strategy to subcutaneous vedolizumab.
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Date
2022-01-24
Type
Article
Subject
Gastroenterology, Pharmacology
Citation
Nassar IO, Cheesbrough J, Quraishi MN, Sharma N. Proposed pathway for therapeutic drug monitoring and dose escalation of vedolizumab. Frontline Gastroenterol. 2022 Jan 24;13(5):430-435. doi: 10.1136/flgastro-2021-102032.
Journal / Source Title
Frontline Gastroenterology
DOI
10.1136/flgastro-2021-102032
PMID
36051956
Publisher
BMJ Publishing Group
Publisher’s URL
https://fg.bmj.com/