Introduction: The advent of biotherapies has radically changed the management of IBD. However, the use of these drugs may in some cases result in to primary non-response or a loss of secondary response. Therapeutic Drug Monitoring (TDM) is a tool that was developed to manage biotherapy as accurately as possible in these situations. Material and methods: This is a retrospective descriptive study spread over 8 years of 53 patients followed for IBD put on anti-TNF(, in whom assays of residual levels of anti-TNF and anti-drug antibodies were carried out. Results: 48 suffer from Crohn’s disease and 5 from ulcerative colitis. Of these patients, 41 were on infliximab and 12 on adalimumab. The TDM performed in front of a primary non-response in 18 patients, and a loss of secondary response in 34 patients. We found immunization in 28% of patients, underdosage in 56%, and 15% had a normal dosage. Therapeutic optimization was adopted in 52% of patients, a switch in 19%, a swap in 25% of patients, and the addition of an immunosuppressant in 6.5%. The evolution was marked by the achievement of a prolonged remission in 69% of these patients. Conclusion: Pharmacological dosage of the residual rate of the anti-TNF and anti-drug antibodies currently constitutes an important element for managing the primary non-response or the loss of secondary response to anti-TNF in patients with IBD treated by biotherapy.

Objective: To report an uncommon presentation of a rare case of autoimmune polyglandular syndrome type IIIb in a patient presenting as well with Small Duct Primary Sclerosing Cholangitis. Clinical Presentation and Intervention: A 42-year-old man presented with jaundice and intermittent fever. Blood tests showed macrocytic anaemia due to vitamin B 12 deficiency compatible with Biermer’s disease. A thyroid function test was consistent with hyperthyroidism compatible with Basedow’s disease. And Liver biopsy revealed signs compatible with Small Duct Sclerosing Cholangitis. A final diagnosis of Small Duct Sclerosing Cholangitis with Biermer’s disease and Basedow’s disease, which constituted autoimmune polyglandular syndrome type IIIb, was made and the patient was treated with L-thyroxine, vitamin B 12 injection and Ursodeoxycholic acid with a impressive improvement during his follow up. Conclusion: This case showed a rare combination between APS type IIIb and Small Duct Sclerosing Cholangitis and that the presence of one autoimmune endocrine disease should prompt clinicians to look for other coexisting autoimmune diseases which may be asymptomatic.