Infliximab Precision Dosing in Inflammatory Bowel Disease (IBD) Patients: A Review of Current Literature

The therapeutic failure of infliximab therapy remains a challenge in patients with inflammatory bowel disease (IBD), and dose optimization is often required. Accelerated or intensified regimes showed value in treating patients in the acute setting with high CRP or low albumin levels, which are suggested by recent guidelines; however, evidence is weak. Therapeutic drug monitoring (TDM), with anti-tumor necrosis factor-alpha (TNF-α) trough levels and antibodies, showed value during maintenance therapy, but not in induction and can guide clinical decisions in patients that might be undertreated with the standard dosing regimen. Combining the impact of therapeutic drug monitoring with a Bayesian forecasting methodology to calculate drug clearance can help on calculating the optimal infliximab dose for patients with ulcerative colitis (UC) and Crohn's disease (CD) on both the induction and maintenance phase. This will help to identify those who need intensification of their current regime to boost the therapeutic effect and those who are non-responders. This review aims to summarize the recent literature regarding infliximab precision dosing in IBD patients using forecasting methodology.