Clinical Pharmacology

Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s

Diana M Negoescu, Eva A Enns, PhD, Brooke Swanhorst, Bonnie Baumgartner, James P Campbell, Mark T Osterman, MD, Konstantinos Papamichael, PhD, Adam S Cheifetz, MD, Byron P Vaughn, MD

Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX.

Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.

Results: The proactive strategy led to fewer flares than the …