{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:08:44Z","timestamp":1791472124274,"version":"4.3.4"},"reference-count":139,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Inflammatory bowel disease, encompassing ulcerative colitis and Crohn\u2019s disease, is characterised by chronic immune-mediated inflammation and variable treatment response. Loss of drug efficacy due to underexposure, pharmacokinetic variability, and immunogenicity remains a key challenge. Therapeutic drug monitoring, using drug levels and anti-drug antibody measurements, is an important strategy for optimising the treatment of inflammatory bowel disease. It helps ensure adequate dosing and can distinguish between pharmacokinetic and mechanistic drug failure. Most evidence pertains to infliximab and adalimumab. Multiple factors influence drug pharmacokinetics, affecting both target drug levels and the doses required to achieve them. These include inflammatory burden, bodyweight, age, disease phenotype, and route of administration, all of which are important considerations for individualising treatment in inflammatory bowel disease. This narrative review explores how special clinical situations\u2014acute severe ulcerative colitis, perianal fistulising Crohn\u2019s disease, hypoalbuminaemia, extremes of body composition, pregnancy, paediatrics, and advanced age\u2014alter drug pharmacokinetics and influence the utility and interpretation of therapeutic drug monitoring in inflammatory bowel disease.<\/jats:p>","DOI":"10.3390\/jcm14227956","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T15:07:31Z","timestamp":1762787251000},"page":"7956","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Therapeutic Drug Monitoring in Special Circumstances in Inflammatory Bowel Disease"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0670-560X","authenticated-orcid":false,"given":"Sebastian","family":"Povlsen","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, St George\u2019s University Hospital NHS Foundation Trust, London SW17 0QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St George\u2019s University Hospital NHS Foundation Trust, London SW17 0QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Roblin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Saint-Etienne University Hospital, 42055 Saint-Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1497-0254","authenticated-orcid":false,"given":"Konstantinos","family":"Papamichael","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6657-2763","authenticated-orcid":false,"given":"Sailish","family":"Honap","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St George\u2019s University Hospital NHS Foundation Trust, London SW17 0QT, UK"},{"name":"School of Immunology and Microbial Sciences, King\u2019s College London, London SE1 9RT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0140-6736(23)00966-2","article-title":"Ulcerative colitis","volume":"402","author":"Berre","year":"2023","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/S0140-6736(23)02586-2","article-title":"Crohn\u2019s disease","volume":"403","author":"Dolinger","year":"2024","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1111\/apt.16723","article-title":"Trends in the use of biologicals and their treatment outcomes among patients with inflammatory bowel diseases\u2014A Danish nationwide cohort study","volume":"55","author":"Zhao","year":"2022","journal-title":"Aliment. 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