Reduced prescription of TNF-inhibitors in chronic arthritis based on therapeutic drug monitoring: A randomized controlled trial
Dosing of tumour necrosis factor-α inhibitors (TNFis) is not personalized causing interindividual variation in serum drug levels; however, dose optimization is not widely implemented. We hypothesized that some patients are overdosed; thus, drug prescription could be reduced by therapeutic drug monit...
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Published in | Scandinavian journal of rheumatology Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 13 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Taylor & Francis
03.09.2023
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Online Access | Get full text |
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Summary: | Dosing of tumour necrosis factor-α inhibitors (TNFis) is not personalized causing interindividual variation in serum drug levels; however, dose optimization is not widely implemented. We hypothesized that some patients are
overdosed; thus, drug prescription could be reduced by therapeutic drug
monitoring (TDM).
Independent of disease activity, 239 adults treated for rheumatoid arthritis (n = 99), psoriatic arthritis 15 (n = 48), or spondyloarthritis (n = 92) were recruited for a 48-week prospective, randomized open-label trial. Standard care alone or plus
TDM was applied in chronic arthritis patients treated with infliximab (IFX), (n
= 81), etanercept (ETN) (n = 79), or adalimumab (ADA) (n = 79). Serum TNFi
trough levels assessed at inclusion and every 4 months determined patients
within/outside predefined therapeutic intervals, supporting change in
prescription or drug switch. The primary endpoint was reduced drug
prescription.
Compared to standard care, TDM reduced prescribed IFX [−12% (95% confidence interval −20, −3); p = 0.001] and ETN (−15% (−29, 1); p = 0.01], and prolonged the interdosing intervals of ETN [+235% (38, 432); p = 0.02] and ADA [+28% (6, 51); p = 0.04]. Time to drug switch was accelerated (χ2 = 6.03, p = 0.01). No group differences in adverse events, disease activity, or self-reported outcomes were shown, indicating equally sustained remission.
TDM reduced prescription of IFX, ETN, and ADA and identified patients benefiting from accelerated drug switch, thereby minimizing treatment failure, risk of toxicity, and unnecessary adverse events. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 |
ISSN: | 0300-9742 1502-7732 1502-7732 |
DOI: | 10.1080/03009742.2022.2121081 |