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The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis

The advent of biological therapies has been a major therapeutic advance in rheumatology. Many patients now enjoy improved quality of life through better disease control. The number of therapies continues to grow both within drug class (including biosimilar drugs) and via new mechanisms. For the firs...

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Autores principales: Perry, Martin, Abdullah, Azhar, Frleta, Marina, MacDonald, Jonathan, McGucken, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011331/
https://www.ncbi.nlm.nih.gov/pubmed/32095163
http://dx.doi.org/10.1177/1759720X20904850
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author Perry, Martin
Abdullah, Azhar
Frleta, Marina
MacDonald, Jonathan
McGucken, Andrew
author_facet Perry, Martin
Abdullah, Azhar
Frleta, Marina
MacDonald, Jonathan
McGucken, Andrew
author_sort Perry, Martin
collection PubMed
description The advent of biological therapies has been a major therapeutic advance in rheumatology. Many patients now enjoy improved quality of life through better disease control. The number of therapies continues to grow both within drug class (including biosimilar drugs) and via new mechanisms. For the first time, nonbiological drugs such as small-molecule inhibitors (Janus kinase inhibitors) have shown clinical equivalence. However, clinical unmet need remains with up to a third of patients commenced on a biologic therapy having minimal or no response: (a) Generally, the first biologic used secures the best response, with likelihood of remission falling thereafter with successive therapies; (b) the success of strategy trials using biological therapies can be difficult to replicate in clinical practice due to a combination of patient factors and service limitations. Accordingly, ensuring optimization of initial treatment is an important consideration before switching to alternatives. Therapeutic drug monitoring (TDM) is the measurement of serum levels of a biologic drug with the aim of improving patient care. It is usually combined with detection of any antidrug antibodies that could neutralize the effect of the therapy. This technology has the potential to be a form of ‘personalized medicine’ by individualizing therapy, in particular, dosing and likelihood of sustained treatment response. It requires a clear relationship between drug dose, blood concentration and therapeutic effect. This paper will outline the technology behind TDM and unpack what we can learn from our colleagues in gastroenterology, where the adoption of TDM is at a more advanced stage than in rheumatology. It will explore and set out a number of clinical scenarios where rheumatologists might find TDM helpful in day-to-day practice. Finally, an outline is given of international developments, including regulatory body appraisals and guideline development.
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spelling pubmed-70113312020-02-24 The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis Perry, Martin Abdullah, Azhar Frleta, Marina MacDonald, Jonathan McGucken, Andrew Ther Adv Musculoskelet Dis Review The advent of biological therapies has been a major therapeutic advance in rheumatology. Many patients now enjoy improved quality of life through better disease control. The number of therapies continues to grow both within drug class (including biosimilar drugs) and via new mechanisms. For the first time, nonbiological drugs such as small-molecule inhibitors (Janus kinase inhibitors) have shown clinical equivalence. However, clinical unmet need remains with up to a third of patients commenced on a biologic therapy having minimal or no response: (a) Generally, the first biologic used secures the best response, with likelihood of remission falling thereafter with successive therapies; (b) the success of strategy trials using biological therapies can be difficult to replicate in clinical practice due to a combination of patient factors and service limitations. Accordingly, ensuring optimization of initial treatment is an important consideration before switching to alternatives. Therapeutic drug monitoring (TDM) is the measurement of serum levels of a biologic drug with the aim of improving patient care. It is usually combined with detection of any antidrug antibodies that could neutralize the effect of the therapy. This technology has the potential to be a form of ‘personalized medicine’ by individualizing therapy, in particular, dosing and likelihood of sustained treatment response. It requires a clear relationship between drug dose, blood concentration and therapeutic effect. This paper will outline the technology behind TDM and unpack what we can learn from our colleagues in gastroenterology, where the adoption of TDM is at a more advanced stage than in rheumatology. It will explore and set out a number of clinical scenarios where rheumatologists might find TDM helpful in day-to-day practice. Finally, an outline is given of international developments, including regulatory body appraisals and guideline development. SAGE Publications 2020-02-07 /pmc/articles/PMC7011331/ /pubmed/32095163 http://dx.doi.org/10.1177/1759720X20904850 Text en © The Author(s), 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Perry, Martin
Abdullah, Azhar
Frleta, Marina
MacDonald, Jonathan
McGucken, Andrew
The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis
title The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis
title_full The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis
title_fullStr The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis
title_full_unstemmed The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis
title_short The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis
title_sort potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011331/
https://www.ncbi.nlm.nih.gov/pubmed/32095163
http://dx.doi.org/10.1177/1759720X20904850
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