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Personalizing IL-23 Inhibitor Therapy in IBD: Current Evidence and Future Directions in Therapeutic Drug Monitoring
Alessandro Pedicelli1, Talat Bessissow1, Waqqas Afif1
1Department of Medicine, Division of Gastroenterology & Hepatology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada.
Journal of Clinical Medicine
|November 13, 2025
Summary
Therapeutic drug monitoring (TDM) for interleukin-23 (IL-23) inhibitors in inflammatory bowel disease (IBD) is under investigation. Current evidence is preliminary, suggesting potential benefits but requiring more robust data before routine clinical use.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Interleukin-23 (IL-23) inhibitors are crucial for inflammatory bowel disease (IBD) treatment.
- Agents like risankizumab, mirikizumab, and guselkumab share similar pharmacokinetic and pharmacodynamic profiles.
- Therapeutic drug monitoring (TDM) is standard for anti-TNF agents but not established for IL-23 inhibitors.
Purpose of the Study:
- To evaluate the current role and emerging evidence for therapeutic drug monitoring (TDM) of IL-23 inhibitors in IBD.
- To assess the potential for dose optimization strategies based on emerging data.
Main Methods:
- Review of emerging evidence, primarily retrospective studies.
- Analysis of pharmacokinetic and pharmacodynamic properties of IL-23 inhibitors.
- Comparison with established TDM practices for other IBD therapies.
Main Results:
- Preliminary data for risankizumab suggests dose-response relationships and potential maintenance thresholds.
- Evidence for TDM efficacy and dose optimization in IL-23 inhibitors is currently limited.
- Existing data is largely retrospective, single-center, and involves small patient cohorts.
Conclusions:
- Routine therapeutic drug monitoring (TDM) for IL-23 inhibitors in IBD is currently investigational.
- More robust evidence is needed to support the efficacy of TDM and dose optimization strategies.
- Further research is required before widespread clinical adoption.
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