IBD: Testing for diagnosis and treatment monitoring
Improving lives through personalized testing
From potentially lengthy diagnostic odysseys to repeated and ongoing monitoring to gauge treatment response, laboratory testing is an important aspect of a patient’s journey with inflammatory bowel disease (IBD). With varying causes and a growing slate of biologic medications to manage symptoms, choosing the best test for your patients can be complicated.
6–8M
6–8 million people globally have IBD1
30–40%
30–40% of patients with IBD lose their response during anti-tumor necrosis factor maintenance therapy2, 3
60%
60% of patients who initially respond to adalimumab lose the response over timE4
13–40%
13–40% of patients with Crohn’s disease who initially respond to infliximab lose their response over time5
Helping patients move forward
When used appropriately, laboratory test results can be a powerful tool to improve the lives of patients affected by IBD. Implementing therapeutic drug monitoring to assess effectivity of tailored treatments provides a deep understanding into a patient’s therapeutic response and personalized insights to optimize medication selection.
End-to-end IBD testing translates into streamlined care that helps patients live symptom-free and move on with their lives.
Our testing use case scenario guide provides a detailed look at how targeted analysis can equip physicians and healthcare professionals with insights to diagnose patients and make treatment decisions.
Cases include:
Diagnostic testing
IBD diagnosis
Monogenic IBD testing
Therapeutic drug monitoring
Proactive testing: adalimumab
Reactive testing: infliximab
Proactive testing: infliximab
Reactive testing: risankizumab
Download now
Inflammatory bowel disease: Diagnostic testing and therapeutic drug monitoring
“Therapeutic drug monitoring is routinely used to assess loss of response to therapy and proactively manage patients taking biologics. It has become standard of care in the gastroenterology practice, especially for inflammatory bowel disease, Crohn's disease, and ulcerative colitis.”
Maria Alice Willrich, Ph.D., Mayo Clinic
Biologics treatment evolution
Biologic medications: an evolving landscape of treatment options
Heightened understanding of the complex pathophysiology of IBD has led to a boom in development of targeted therapies that focus on different aspects of the inflammatory process. In the last 10 years alone, eight new drugs, as well as biosimilar medications and subcutaneous versions of several drugs, have received approval from the U.S. Food and Drug Administration.
Anti-tumor necrosis factor agents block tumor necrosis factor (TNF)-mediated activation of proinflammatory pathways by using monoclonal antibody targeting to induce remission.
Infliximab and biosimilars
Adalimumab and biosimilars
Certolizumab (Crohn’s disease only)
Golimumab (ulcerative colitis only)
Anti-integrins block the movement of leukocytes to the site of inflammation within the intestinal vasculature.
Vedolizumab
Natalizumab
Interleukin 12/23 inhibitor uses monoclonal antibodies that block interleukin-12 and -23, which are key cytokines in IBD pathogenesis.
Ustekinumab
Interleukin 23 inhibitors use monoclonal antibodies that block interleukin-23, which is a key cytokine in IBD pathogenesis.
Risankizumab-rzaa
Mirikizumab-mrkz (ulcerative colitis only)
Real-world impact of personalized medicine
For most of his adult life, Billy Dowell Jr. has lived with a serious immune-mediated disease process that causes multiple conditions, including ulcerative colitis. As a result of consistent follow-up care, biologic therapy, and laboratory testing to monitor his treatment, Billy’s symptoms have been well controlled for more than a decade.
“Laboratory test results are a great affirmation,” says Billy. “It takes a lot for me to want to slow down, but if I do experience that, or I think my disease is flaring, then I have the confidence that the laboratory is getting that information. With the test confirmation we know where to go with me.”
Maria Alice Willrich, Ph.D., explains how Mayo Clinic Laboratories' new assay provides therapeutic drug monitoring of risankizumab, or RISA. Test results help guide care for patients with plaque psoriasis, psoriatic arthritis, and Crohn's disease.
PACE/FL - This webinar will cover the laboratory tests available at Mayo Clinic Laboratories to monitor patients using monoclonal antibody therapies for treatment of inflammatory bowel disease. Focus will be shared between analytical approaches as well as literature and practice recommendations for test results interpretation.
Maria Willrich, Ph.D., and Melissa Snyder, Ph.D., describe Mayo Clinic Laboratories' panel for proactive therapeutic drug monitoring of patients with inflammatory bowel disease. The panel expands options for clinicians assessing patients' response to infliximab and adalimumab.
Download Ulcerative Colitis and Crohn Disease Therapeutic Drug Monitoring Algorithm
References
Alatab S, Sepanlou S, Ikuta K, et al. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(1):17-30. https://doi.org/10.1016/S2468-1253(19)30333-4.
Genaro LM, Gomes LEM, Franceschini APMF, et al. Anti-TNF therapy and immunogenicity in inflammatory bowel diseases: a translational approach. Am J Transl Res. 2021 Dec 15;13(12):13916-13930. PMID: 35035733; PMCID: PMC8748125.
Kennedy NA, Heap GA, Green HD, et al. Predictors of anti-TNF treatment failure in anti-TNF-naive patients with active luminal Crohn’s disease: a prospective, multicentre, cohort study. Lancet Gastroenterol Hepatol. 2019;4(5):341-353.
Willrich MAV, Murray DL, Snyder MR. Tumor necrosis factor inhibitors: clinical utility in autoimmune diseases. Transl Res. 2015;165(2):270-282.
Li X, Zhong Y, Yuan C, et al. Identifying patients with Crohn's disease at high risk of primary nonresponse to infliximab using a radiomic-clinical model. Int J Intell Syst. 2022 Sept;37(12): 11853-11870. https://doi.org/10.1002/int.23066.
Cheifetz AS, Abreu MT, Afif W, et al. A comprehensive literature review and expert consensus statement on therapeutic drug monitoring of biologics in inflammatory bowel disease. Am J Gastroenterol. 2021 Oct 1;116(10):2014-2025. doi:10.14309/ajg.0000000000001396. PMID: 34388143; PMCID: PMC9674375.
Learn more about how testing can support evidence-based diagnosis and treatment strategies.
