Current Practice of Therapeutic Drug Monitoring of Biopharmaceuticals in Psoriasis Patients

Abstract

The high prevalence of psoriasis and the high spending on pharmaceuticals motivate a more evidence-based and cost-effective usage of biopharmaceuticals. A growing body of evidence exists that the implementation of therapeutic drug monitoring for biopharmaceuticals in psoriasis patients optimizes patient management and clinical outcome and enhances their efficacy. Therefore, the aim of this review was to give an overview of the literature on therapeutic drug monitoring of biopharmaceuticals in the treatment of psoriasis and to provide the useful information to dermatologists to improve health care in psoriasis patients.

Practical recommendations for the use of therapeutic drug monitoring of biopharmaceuticals in inflammatory diseases

“…However, for the other biopharmaceuticals such as certolizumab pegol, golimumab, vedolizumab, ustekinumab, secukinumab, alemtuzumab and abatacept, data supporting a role for TDM are still particularly scarce 20,22,24–31…”

“…A more than 10-fold interindividual variation in trough concentrations (ie, the serum or plasma concentration just before a next infusion) has been described 26,32–34. Furthermore, adequate drug trough concentrations have been linked to response (clinical response, biomarker response, endoscopic response, etc) in different inflammatory diseases 18–22. As the correlation between drug blood concentrations and outcome is stronger than between dose and outcome, measuring drug concentrations is an essential part of TDM, and allows optimization of the therapeutic dosage regimen and thereby improvement of the response.…”

“…With reported turnaround times of 3 working days to more than a week, it is not possible to “act upon” the measurement at the time the sample is taken, implying that TDM is always one administration late 56,66. Therefore, the appropriate turnaround time for reporting the analytical results to the physician should allow at least action upon the next administration of the drug and therefore depends on the administration interval and consequently is drug specific 18–22. Turnaround time and therefore TDM are hampered by pre-analytical (eg, transportation of the samples), analytical (eg, sample pretreatment as measurements are performed on serum/plasma and not on full blood) and post-analytical (eg, delays in the reporting to action time) procedures.…”

“…For infliximab and adalimumab, the immunogenicity–exposure–response correlation has repeatedly been described and therapeutic trough concentration thresholds have been suggested 22. Etanercept, on the other hand, is less immunogenic and trough concentrations vary less 22,104.…”

“…Etanercept, on the other hand, is less immunogenic and trough concentrations vary less 22,104. Detrez et al104 recently observed an age-dependent exposure–response relation for etanercept.…”