1.0.0.0 Rec­om­men­da­tions and GRADE

1.1.0.0 Rec­om­men­da­tions

Sr.­no.

Rec­om­men­da­tions

SoR

QoE

1

In adults with ac­tive IBD treat­ed with anti-‍TNF agents, the AGA sug­gests reac­tive ther­a­peu­tic drug mon­i­tor­ing to guide treat­ment changes. Con­di­tion­al rec­om­men­da­tion, very low qual­i­ty of ev­i­dence.

Com­ment: Table 4 sum­ma­rizes sug­gest­ed trough con­cen­tra­tion for anti-‍TNF ther­a­py, for pa­tients with ac­tive IBD on main­te­nance ther­a­py. Of note, there may be a small sub­set of pa­tients who may still re­spond by tar­get­ing high­er tar­get con­cen­tra­tions. Op­ti­mal trough con­cen­tra­tions for in­duc­tion ther­a­py are un­cer­tain.

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 1

2

In adult pa­tients with qui­es­cent IBD treat­ed with anti-‍TNF agents, the AGA makes no rec­om­men­da­tion re­gard­ing the use of rou­tine proac­tive ther­a­peu­tic drug mon­i­tor­ing.

N/A

Know­ledge gap

Ev­i­dence for Rec­om­men­da­tion 2

3

In adult pa­tients with IBD being start­ed on thiop­urines, the AGA sug­gests rou­tine TPMT test­ing (en­zy­mat­ic ac­tiv­i­ty or geno­type) to guide thiop­urine dos­ing.

Com­ment: Rou­tine lab­o­ra­to­ry mon­i­tor­ing, in­clud­ing CBC, should be per­formed, re­gard­less of TPMT test­ing re­sults.

Cond

Low

Ev­i­dence for Rec­om­men­da­tion 3

4

In adult pa­tients treat­ed with thiop­urines with ac­tive IBD or ad­verse ef­fects thought to be due to thiop­urine tox­i­c­i­ty, the AGA sug­gests reac­tive thiop­urine metabo­lite mon­i­tor­ing to guide treat­ment changes.

Com­ment: When mea­sur­ing thiop­urine metabo­lite mon­i­tor­ing in pa­tients with ac­tive IBD-‍re­lat­ed symp­toms, we sug­gest a tar­get 6-‍thiogua­nine (6-TGN) cut­off be­tween 230−450 pmol/8 × 108 RBCs when used as monother­a­py; op­ti­mal 6-TGN cut­off when thiop­urines are used in com­bi­na­tion with anti-‍TNF agents is un­cer­tain.

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 4

5

In adult pa­tients with qui­es­cent IBD treat­ed with thiop­urines, the AGA sug­gests against rou­tine thiop­urine metabo­lite mon­i­tor­ing.

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 5

SoR: Strength of Rec­om­men­da­tion
QoE: Qual­i­ty of Ev­i­dence
Strong: Strong Rec­om­men­da­tion
Cond: Con­di­tion­al Rec­om­men­da­tion
High: High-‍Qual­i­ty Ev­i­dence
Mod: Mod­er­ate-Qual­i­ty Ev­i­dence
Low: Low-‍Qual­i­ty Ev­i­dence
V Low: Very Low-‍Qual­i­ty Ev­i­dence