{"doi":"10.1093/ibd/izaa102","title":"Effect of a Practice-wide Anti-TNF Proactive Therapeutic Drug Monitoring Program on Outcomes in Pediatric Patients with Inflammatory Bowel Disease","abstract":"BACKGROUND: Reports on the feasibility and effectiveness of translating proactive, antitumor necrosis factor (TNF) therapeutic drug monitoring (TDM) for inflammatory bowel disease into practice-wide quality improvement (QI) are lacking. We aimed to determine whether a TDM QI program improved outcomes at a large academic pediatric gastroenterology practice. METHODS: We instituted local anti-TNF TDM practice guidelines to proactively monitor and optimize drug levels (goal >5 μg/mL). We conducted a retrospective single-center cohort analysis of patient outcomes before (pre-TDM) and after (post-TDM) guideline institution and assessed the independent effect by multivariable regression. Primary outcome was sustained clinical remission (SCR22-52), defined as physician global assessment (PGA) of inactive from 22 to 52 weeks and off corticosteroids at 52 weeks. RESULTS: We identified 108 pre-TDM and 206 post-TDM patients. The SCR22-52 was achieved in 42% of pre-TDM and 59% of post-TDM patients (risk difference, 17.6%; 95% CI, 5.4-29%; P = 0.004). The post-TDM group had an increased adjusted odds of achieving SCR22-52 (odds ratio, 2.03; 95% CI, 1.27-3.26; P = 0.003). The adjusted risk of developing high titer antidrug antibodies (ADAs) was lower in the post-TDM group (hazard ratio, 0.18; 95% CI, 0.09-0.35; P < 0.001). Although the risk of anti-TNF cessation for any reason was not significantly different, there was a lower adjusted risk of cessation related to any detectable ADA in the post-TDM group (hazard ratio, 0.45; 95% CI, 0.26-0.77; P = 0.003). CONCLUSIONS: A practice-wide proactive anti-TNF TDM QI program improved key clinical outcomes at our institution, including sustained clinical remission, incidence of high titer ADA, and anti-TNF cessation related to ADA.","journal":"Inflammatory Bowel Diseases","year":2020,"id":62025,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":53,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9416,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":330069,"name":"Aditi Mulgund","orcid":null,"position":1,"is_corresponding":false},{"id":328240,"name":"Laura E. Bauman","orcid":"0000-0002-9753-5946","position":2,"is_corresponding":false},{"id":328241,"name":"Weizhe Su","orcid":"0000-0002-3423-0053","position":3,"is_corresponding":false},{"id":328242,"name":"Lin Fei","orcid":"0000-0002-8187-6295","position":4,"is_corresponding":false},{"id":330070,"name":"Deepika L. Chona","orcid":null,"position":5,"is_corresponding":false},{"id":328243,"name":"Puneet Sharma","orcid":"0000-0003-3346-3928","position":6,"is_corresponding":false},{"id":330071,"name":"Renee K. Etter","orcid":null,"position":7,"is_corresponding":false},{"id":328244,"name":"Jennifer Hellmann","orcid":"0000-0002-9774-3518","position":8,"is_corresponding":false},{"id":291505,"name":"Lee A. Denson","orcid":"0000-0001-8045-7198","position":9,"is_corresponding":false},{"id":307304,"name":"Phillip Minar","orcid":"0000-0003-4223-4211","position":10,"is_corresponding":false},{"id":328245,"name":"Dana M. H. Dykes","orcid":"0000-0002-1846-8766","position":11,"is_corresponding":false},{"id":35639,"name":"Michael J. Rosen","orcid":"0000-0002-5149-718X","position":12,"is_corresponding":false},{"id":328239,"name":"John L. Lyles","orcid":"0000-0001-5825-8029","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-18T21:10:11.612909Z","pmid":"32448898","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}