ASSESSING ANTI-TNF TROUGH LEVELS AND ITS APPLICABILITY IN DAILY PRACTICE IN SPONDYLOARTHRITIS PATIENTS

Claudia Deaconu,Daniela Opris,Ruxandra Ionescu

doi:10.37897/rjr.2016.3.5

Abstract

Objective. The purpose of the present study was to assess the relevance of therapeutic drug monitoring in spondyloarthritis patients, by determining drug serum levels and anti-drug antibodies and estimating cut-off values for three TNF inhibitors. Methods. Over one year, we enrolled 100 patients with SpA, under consequent treatment with adalimumab (ADL), etanercept (ETA) or infliximab (IFX). Demographic, clinical (BASDAI, ASDAS) and laboratory (ESR, CRP) data was collected together with drug serum level and anti-drug antibodies using the ELISA technique. The statistical analysis was performed using the SPSS software, version 20.0 with the aid of Student t-test, Spearman and Pearson tests. Results. Out of the study cohort, 35% were on ADL, 33% on IFX, and 32% under ETA treatment. Undetectable drug levels correlated to the presence of anti-drug antibodies and to disease activity scores. There were no identified anti-ETA antibodies. For this study lot trough levels are estimated between 2 and 4 μg/mL for an ASDAS-CRP under 2.1. Conclusion. Serum drug level measurement and anti-drug antibody detection can be used as a completion to a clinician’s tools in assessing disease activity, leading to an optimal and personalized manner of patient management.

Highlights

AND OBJECTIVESIn spite the heterogeneous clinical presentation of spondyloarthritis (SpA) spectrum affections, they share the same therapeutical options
Introducing anti-TNF agents as second line treatment has revolutionized the outcome of these patients [1]
Following the rheumatoid arthritis “model” [2,3,4,5] and recent trend of personalized medicine, latest studies propose therapeutic drug monitoring (TDM) in SpA patients [6,7]. This consists of drug level dosing and anti-drug antibodies detection that would help practitioners have a more realistic approach face to biological therapy

Summary

Introduction

AND OBJECTIVESIn spite the heterogeneous clinical presentation of spondyloarthritis (SpA) spectrum affections, they share the same therapeutical options. Introducing anti-TNF (tumor necrosis factor) agents as second line treatment has revolutionized the outcome of these patients [1] Setbacks such as loss or lack of response, side effect occurrence or high costs have constantly challenged clinicians. Following the rheumatoid arthritis “model” [2,3,4,5] and recent trend of personalized medicine, latest studies propose therapeutic drug monitoring (TDM) in SpA patients [6,7]. This consists of drug level dosing and anti-drug antibodies detection that would help practitioners have a more realistic approach face to biological therapy. It can lead to correctly identifying patients who would benefit from dose augmentation, therapy spacing or switching to another agent

Methods

Results

Conclusion