Lookup NU author(s): Dr Nina Wilson,
Professor Nick Reynolds
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Biologics have transformed management of inflammatory diseases. To optimize outcomesand reduce costs, dose adjustment informed by circulating drug levels has been proposed. Weaimed to determine the real-world clinical utility of therapeutic drug monitoring in psoriasis.Within a multicenter (n=60) prospective observational cohort, 544 psoriasis patients wereincluded who were on adalimumab monotherapy, with at least one serum sample and PASI(Psoriasis Area and Severity Index) score available within the first year. We present modelsgiving individualized probabilities of response for any given drug level: a minimally effectivedrug level of 3.2 μg/ml discriminates responders (PASI75: 75% improvement in baselinePASI) from non-responders and gives an estimated PASI75 probability of 65% (95% CI 60-71%). At 7ug/ml, PASI75 probability is 81% (95% CI 76-86%); beyond 7ug/ml, the druglevel/response curve plateaus. Crucially, drug levels are predictive of response 6 monthslater, whether sampled early or at steady state. We confirm serum drug level to be the mostimportant factor determining treatment response, highlighting the need to take drug levelsinto account when searching for biomarkers of response.This real-world study with pragmatic drug level sampling provides evidence to support theproactive measurement of adalimumab levels in psoriasis to direct treatment strategy, and isrelevant to other inflammatory diseases.
Author(s): Wilkinson N, Tsakok T, Dand N, Bloem K, Duckworth M, Baudry D, Pushpa-Rajah A, Griffiths CEM, Reynolds N, Barker J, Warren RB, Burden AD, Rispens T, Stocken D, Smith C, BSTOP study group, PSORT consortium
Publication type: Article
Publication status: Published
Journal: Journal of Investigative Dermatology
Print publication date: 01/01/2019
Online publication date: 18/08/2018
Acceptance date: 15/07/2018
Date deposited: 10/10/2018
ISSN (print): 0022-202X
ISSN (electronic): 1523-1747
Publisher: Nature Publishing Group
Altmetrics provided by Altmetric