1.0.0.0 Recommendations and GRADE
1.1.0.0 Recommendations
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Sr.no. |
Recommendations |
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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. |
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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 |
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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 |
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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 |
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5 |
In adult patients with quiescent IBD treated with thiopurines, the AGA suggests against routine thiopurine metabolite monitoring. |
Cond |
V Low |