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Clinical Pharmacokinetic and Pharmacodynamic Considerations in the Treatment of Inflammatory Bowel Disease

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Abstract

According to recent clinical consensus, pharmacotherapy of inflammatory bowel disease (IBD) is, or should be, personalized medicine. IBD treatment is complex, with highly different treatment classes and relatively few data on treatment strategy. Although thorough evidence-based international IBD guidelines currently exist, appropriate drug and dose choice remains challenging as many disease (disease type, location of disease, disease activity and course, extraintestinal manifestations, complications) and patient characteristics [(pharmaco-)genetic predisposition, response to previous medications, side-effect profile, necessary onset of response, convenience, concurrent therapy, adherence to (maintenance) therapy] are involved. Detailed pharmacological knowledge of the IBD drug arsenal is essential for choosing the right drug, in the right dose, in the right administration form, at the right time, for each individual patient. In this in-depth review, clinical pharmacodynamic and pharmacokinetic considerations are provided for tailoring treatment with the most common IBD drugs. Development (with consequent prospective validation) of easy-to-use treatment algorithms based on these considerations and new pharmacological data may facilitate optimal and effective IBD treatment, preferably corroborated by effectiveness and safety registries.

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Authors and Affiliations

  1. Department of Clinical Pharmacy and Pharmacology, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands

    Luc J. J. Derijks

  2. Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands

    Dennis R. Wong

  3. Center for Inflammatory Bowel Diseases, UCLA, Los Angeles, CA, USA

    Daniel W. Hommes

  4. Department of Gastroenterology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands

    Adriaan A. van Bodegraven

  5. Department of Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands

    Adriaan A. van Bodegraven

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  1. Luc J. J. Derijks
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  2. Dennis R. Wong
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  3. Daniel W. Hommes
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  4. Adriaan A. van Bodegraven
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Correspondence to Luc J. J. Derijks.

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No funding was received for preparation of this manuscript.

Conflict of interest

Luc Derijks and Dennis Wong have no conflicts of interest to declare. Daniel Hommes received research support, consultancy fees, and educational support from Ferring, Otsuka, Leo Pharma, Novimmune, Roche, Centocor, Schering Plough, Johnson & Johnson, PDL BioPharma, ELAN, Proctor-Gamble, Chemocentryx, AbbVie, UCB, Cellerix, AstraZeneca, Giuliani Pharma, Genentech, BMS, Philips, MSD, Serono, Falk, Genova, Takeda and Gilead. Adriaan van Bodegraven received speaker’s fees, and travel and educational support from AbbVie, Ferring, Janssen, Pfizer, MSD, Takeda, and TEVA. A Consultancy fees were provided by MSD, Pfizer, TEVA and Tramedico, and research grants were provided by ZonMW.

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Derijks, L.J.J., Wong, D.R., Hommes, D.W. et al. Clinical Pharmacokinetic and Pharmacodynamic Considerations in the Treatment of Inflammatory Bowel Disease. Clin Pharmacokinet 57, 1075–1106 (2018). https://doi.org/10.1007/s40262-018-0639-4

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