Suivi thérapeutique pharmacologique des anti-TNF-α au cours des spondyloarthrites

Abstract

TNF-α antagonists have profoundly changed the way we care for patients suffering severe refractory spondyloarthritis (SpA). However, the clinical response varies across patients, some have a sustained remission while others are non-responders or present secondary loss of response. These failures are caused by either immunization (for monoclonal antibodies), low exposure (or serum concentration) or, in some cases, due to the lack of implication of TNF-α in the pathophysiology of the condition. In this article the authors discuss and debate the arguments involving therapeutic drug monitoring (TDM) in light of the relevant literature. Although a rational reason exists to support TDM in SpA with TNF-α antagonist, the available data are somehow contradictory and no comparative randomized trial have been conducted to demonstrate its added value as compared with usual care. A better understanding of the concentration–response relationship is warranted before using TDM in clinical practice in SpA with TNF-α antagonist.