Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study

Lise Pedersen, 1 Pal Bela Szecsi, 1 Per Birger Johansen, 2 Poul Jannik Bjerrum 1 1Department of Clinical Biochemistry, University of Copenhagen, Holbæk Hospital, Holbæk, Denmark; 2Department of Rheumatology, University of Copenhagen, Holbæk Hospital, Holbæk,...

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Autores principales:	Pedersen L, Szecsi PB, Johansen PB, Bjerrum PJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	infliximab adalimumab etanercept golimumab anti-drug antibodies Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/8ce6c057476541f09ee7202709315479
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spelling	oai:doaj.org-article:8ce6c057476541f09ee72027093154792021-12-02T11:38:23ZEvaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study1177-5491https://doaj.org/article/8ce6c057476541f09ee72027093154792020-10-01T00:00:00Zhttps://www.dovepress.com/evaluation-of-therapeutic-drug-monitoring-in-the-clinical-management-o-peer-reviewed-article-BTThttps://doaj.org/toc/1177-5491Lise Pedersen, 1 Pal Bela Szecsi, 1 Per Birger Johansen, 2 Poul Jannik Bjerrum 1 1Department of Clinical Biochemistry, University of Copenhagen, Holbæk Hospital, Holbæk, Denmark; 2Department of Rheumatology, University of Copenhagen, Holbæk Hospital, Holbæk, DenmarkCorrespondence: Lise Pedersen Department of Clinical BiochemistryUniversity of Copenhagen, Holbæk Hospital, Holbæk Hospital, Smedelundsgade 60, Holbæk 4300, DenmarkTel +45 59484403Email liseped@regionsjaelland.dkPurpose: Treatment of rheumatic diseases with tumor necrosis factor inhibitors leads to improved clinical outcomes. Therapeutic drug monitoring (TDM) may assist in guiding clinical decisions. This study investigates the impact of TDM on clinical outcome, decision-making and biologics cost expenditure.Patients and Methods: In a retrospective observational study of 306 patients with rheumatic diseases treated with four different tumor necrosis factor inhibitors, drug levels and antidrug antibodies were measured over a period of one year. Primary outcomes were the clinicians’ response to each TDM result and the clinical outcome two years after TDM initiation. Outcomes were compared between the 111 TDM-guided patients and the 195 empirically guided patients.Results: Treatment change occurred in 55% of the patients in the TDM group, but in only 38% in the empirically guided group. In the TDM group, 89 (79.5%) patients were in remission or had low disease activity after two years follow-up compared to 128 (65.6%) patients in the empirical group. The average cost of biologics per patient per year was lower in the TDM group than in the empirical group for patients receiving infliximab, adalimumab or etanercept at baseline but not for golimumab.Conclusion: TDM-guided decision-making is useful in rheumatic patients receiving TNFi and may optimize therapeutic decisions, leading to a better control of disease activity. Proactive TDM may support decisions on dose tapering, resulting in lower drug consumption and biologics cost expenditure.Keywords: infliximab, adalimumab, etanercept, golimumab, anti-drug antibodiesPedersen LSzecsi PBJohansen PBBjerrum PJDove Medical Pressarticleinfliximabadalimumabetanerceptgolimumabanti-drug antibodiesMedicine (General)R5-920ENBiologics: Targets & Therapy, Vol Volume 14, Pp 115-125 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	infliximab adalimumab etanercept golimumab anti-drug antibodies Medicine (General) R5-920
spellingShingle	infliximab adalimumab etanercept golimumab anti-drug antibodies Medicine (General) R5-920 Pedersen L Szecsi PB Johansen PB Bjerrum PJ Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study
description	Lise Pedersen, 1 Pal Bela Szecsi, 1 Per Birger Johansen, 2 Poul Jannik Bjerrum 1 1Department of Clinical Biochemistry, University of Copenhagen, Holbæk Hospital, Holbæk, Denmark; 2Department of Rheumatology, University of Copenhagen, Holbæk Hospital, Holbæk, DenmarkCorrespondence: Lise Pedersen Department of Clinical BiochemistryUniversity of Copenhagen, Holbæk Hospital, Holbæk Hospital, Smedelundsgade 60, Holbæk 4300, DenmarkTel +45 59484403Email liseped@regionsjaelland.dkPurpose: Treatment of rheumatic diseases with tumor necrosis factor inhibitors leads to improved clinical outcomes. Therapeutic drug monitoring (TDM) may assist in guiding clinical decisions. This study investigates the impact of TDM on clinical outcome, decision-making and biologics cost expenditure.Patients and Methods: In a retrospective observational study of 306 patients with rheumatic diseases treated with four different tumor necrosis factor inhibitors, drug levels and antidrug antibodies were measured over a period of one year. Primary outcomes were the clinicians’ response to each TDM result and the clinical outcome two years after TDM initiation. Outcomes were compared between the 111 TDM-guided patients and the 195 empirically guided patients.Results: Treatment change occurred in 55% of the patients in the TDM group, but in only 38% in the empirically guided group. In the TDM group, 89 (79.5%) patients were in remission or had low disease activity after two years follow-up compared to 128 (65.6%) patients in the empirical group. The average cost of biologics per patient per year was lower in the TDM group than in the empirical group for patients receiving infliximab, adalimumab or etanercept at baseline but not for golimumab.Conclusion: TDM-guided decision-making is useful in rheumatic patients receiving TNFi and may optimize therapeutic decisions, leading to a better control of disease activity. Proactive TDM may support decisions on dose tapering, resulting in lower drug consumption and biologics cost expenditure.Keywords: infliximab, adalimumab, etanercept, golimumab, anti-drug antibodies
format	article
author	Pedersen L Szecsi PB Johansen PB Bjerrum PJ
author_facet	Pedersen L Szecsi PB Johansen PB Bjerrum PJ
author_sort	Pedersen L
title	Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study
title_short	Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study
title_full	Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study
title_fullStr	Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study
title_full_unstemmed	Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study
title_sort	evaluation of therapeutic drug monitoring in the clinical management of patients with rheumatic diseases: data from a retrospective single-center cohort study
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/8ce6c057476541f09ee7202709315479
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Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study

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