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Original research
UK National Survey of Gastroenterologists’ attitudes and barriers toward therapeutic drug monitoring of anti-TNF therapy in inflammatory bowel disease
  1. Gaurav B Nigam1,
  2. Shadab Nayeemuddin1,
  3. Evangelos Kontopantelis2,
  4. Bu'Hussain Hayee3,4,
  5. Jimmy K Limdi1,5
  1. 1Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK
  2. 2Division of Informatics, Imaging & Data Sciences; Faculty of Medicine, Biology & Health, The University of Manchester, Manchester, UK
  3. 3Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
  4. 4Gastroenterology, King's College London, London, UK
  5. 5Gastroenterology, The University of Manchester, Manchester, UK
  1. Correspondence to Professor Jimmy K Limdi, Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester OL1 2JH, UK; Jimmy.Limdi{at}


Background Evidence supports use of therapeutic drug monitoring (TDM) in improving efficacy and cost-effectiveness of anti-tumour necrosis factor (TNF) therapy in inflammatory bowel disease (IBD). Our objective was to assess attitudes and barriers towards TDM use with anti-TNF’s in the UK.

Methods A 17-question survey was distributed to members of the British Society of Gastroenterology by email.

Results Of 243 respondents (51.6% male), 237 respondents met inclusion criteria. Of these, 46% were consultants (gastroenterologist, GI), 39.2% IBD nurse specialists (clinical nurse specialists, CNS), 14.8% registrars. TDM is used by 96.9% for secondary loss of response; 72.5% for primary non-response and 54.1% used TDM proactively. Barriers were time lag in receiving results (49.8%), lack of awareness of guidelines (46.4%) and cost (29.9%). Clinicians working at a teaching hospital (OR 2.6, 95% CI 0.71 to 9.8), IBD CNS and GI registrars (OR 2.6, 95% CI 0.7 to 10 and OR 1.5, 95% CI 0.3 to 7.2, respectively) were more likely to use TDM. Clinicians practising for >20 years (OR 4.1, 95% CI 0.4 to 41.8) and a large volume IBD practice (>50% IBD patients per month) were more likely to use TDM (OR 45.7, 95% CI 7.5 to 275). Proactive TDM, was more likely to be used in tertiary care (OR 2.25, 95% CI 0.84 to 6.1), IBD CNS (OR 1.2, 95% CI 0.7 to 2.1) and clinicians managing >50% IBD patients per month (OR 10.8, 95% CI 1.3 to 90.3). Clinicians with 5–9 years of experience in practice were more likely to use proactive TDM (OR 2.6 and CI 1.04 to 6.4).

Conclusion Validation of point of care and lower cost assays, reduced time lag from test to result, lower cost of testing and dissemination of current recommendations may further optimise treatment strategies.

  • inflammatory bowel disease
  • antibody targeted therapy
  • Crohn's disease
  • drug metabolism
  • ulcerative colitis
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  • Contributors JKL conceived the study. GBN, SN and JKL prepared and modified the questionnaire. BH crucially evaluated the questionnaire. JKL, GBN and SN wrote the manuscript. EK performed statistical analysis. All authors (GBN, SN, EK, BH, JKL) critically evaluated the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JKL has received consultancy and speaker fees from MSD, Abbvie, Janssen, Pfizer and Takeda and research support from Takeda pharmaceuticals.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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