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REPORT DDW 2015: New Research on Proactive Monitoring in Inflammatory Bowel Disease and on Identifying Biomarkers of Relapse Faculty Marla Dubinsky, MD Professor of Pediatrics Chief, Pediatric Gastroenterology Co-Director of the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center Icahn School of Medicine at Mount Sinai Hospital New York, New York

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he search for biomarkers in inflammatory bowel disease (IBD) to monitor disease activity, predict disease progression, or monitor treatment success continues to be an active area of research, and was a key focus of various presentations at Digestive Disease Week (DDW), which took place in Washington, DC, from May 16-19, 2015. Monitoring drug concentrations and antidrug antibodies to anti–tumor necrosis factor (TNF) therapy can help explain why patients have lost response to therapy after an initial benefit, a phenomenon known as “secondary loss of response.” Algorithms suggest that loss of response due to low

drug trough concentrations can be remedied by dose intensification and that patients with antidrug antibodies can benefit by switching drugs within the same therapeutic class.1 However, these reactive recommendations do not allow for proactive dose intensification, and patients are required to fail therapy before the possible mechanism is revealed. In contrast, more recent publications support the use of proactive drug monitoring; for example, studies have shown that patients with a higher trough concentration post-induction (week 14) had better outcomes at week 54 of treatment.2,3 The TAXIT (Trough level Adapted infliXImab Treatment) trial demonstrated that proactive dose adjustment kept trough concentrations at levels between 3 and 7 U/mL, and resulted in more efficient use of the drug.4 All of these prospective studies involved infliximab, but at DDW 2015, the predictive value of adalimumab drug concentrations was also described. Previously, the POCER (Post-Operative Crohn’s Endoscopic Recurrence) study showed that adalimumab decreased endoscopic recurrence when compared with nonbiologic therapy in patients considered at highest risk for

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