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Expert Opin Drug Metab Toxicol. 2017 Jul 17:1-15. doi: 10.1080/17425255.2017.1353602. [Epub ahead of print]

Clinical utility of therapeutic drug monitoring in biological disease modifying anti-rheumatic drug treatment of rheumatic disorders: a systematic narrative review.

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a Department of Rheumatology , Sint Maartenskliniek Nijmegen , The Netherlands.
b Department of Pharmacy , Sint Maartenskliniek , Nijmegen , The Netherlands.
c Department of Pharmacy , Radboudumc Nijmegen , The Netherlands.
d Department of Pharmacology-Toxicology , Radboudumc , Nijmegen , The Netherlands.
e Department of Internal Medicine , Radboudumc , Nijmegen , The Netherlands.
f Department of Rheumatology , Radboudumc , Nijmegen , the Netherlands.



Biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) have improved the treatment outcomes of inflammatory rheumatic diseases including Rheumatoid Arthritis and spondyloarthropathies. Inter-individual variation exists in (maintenance of) response to bDMARDs. Therapeutic Drug Monitoring (TDM) of bDMARDs could potentially help in optimizing treatment for the individual patient. Areas covered: Evidence of clinical utility of TDM in bDMARD treatment is reviewed. Different clinical scenarios will be discussed, including: prediction of response after start of treatment, prediction of response to a next bDMARD in case of treatment failure of the first, prediction of successful dose reduction or discontinuation in case of low disease activity, prediction of response to dose-escalation in case of active disease and prediction of response to bDMARD in case of flare in disease activity. Expert opinion: The limited available evidence does often not report important outcomes for diagnostic studies, such as sensitivity and specificity. In most clinical relevant scenarios, predictive value of serum (anti-) drug levels is absent, therefore the use of TDM of bDMARDs cannot be advocated. Well-designed prospective studies should be done to further investigate the promising scenarios to determine the place of TDM in clinical practice.


Inflammatory rheumatic diseases; biological disease modifying anti-rheumatic drugs; biologicals; rheumatoid arthritis; spondyloarthropathies; therapeutic drug monitoring

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