| Autor: |
M Pfeiffer-Jensen, D Liao, U Tarp, B Deleuran, K Stengaard-Pedersen, J Venborg, B Brock, C Brock |
| Rok vydání: |
2022 |
| Předmět: |
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| Zdroj: |
Pfeiffer-Jensen, M, Liao, D, Tarp, U, Deleuran, B, Stengaard-Pedersen, K, Venborg, J, Brock, B & Brock, C 2022, ' Reduced prescription of TNF-inhibitors in chronic arthritis based on therapeutic drug monitoring : A randomized controlled trial ', Scandinavian Journal of Rheumatology . https://doi.org/10.1080/03009742.2022.2121081 |
| DOI: |
10.6084/m9.figshare.21438072.v1 |
| Popis: |
OBJECTIVE: Dosing of tumour necrosis factor-α inhibitors (TNFis) is not personalized causing interindividual variation in serum drug levels; however, dose optimization is not widely implemented. We hypothesized that some patients are overdosed; thus, drug prescription could be reduced by therapeutic drug monitoring (TDM).METHOD: Independent of disease activity, 239 adults treated for rheumatoid arthritis (n = 99), psoriatic arthritis 15 (n = 48), or spondyloarthritis (n = 92) were recruited for a 48-week prospective, randomized open-label trial. Standard care alone or plus TDM was applied in chronic arthritis patients treated with infliximab (IFX), (n = 81), etanercept (ETN) (n = 79), or adalimumab (ADA) (n = 79). Serum TNFi trough levels assessed at inclusion and every 4 months determined patients within/outside predefined therapeutic intervals, supporting change in prescription or drug switch. The primary endpoint was reduced drug prescription.RESULTS: Compared to standard care, TDM reduced prescribed IFX [-12% (95% confidence interval -20, -3); p = 0.001] and ETN (-15% (-29, 1); p = 0.01], and prolonged the interdosing intervals of ETN [+235% (38, 432); p = 0.02] and ADA [+28% (6, 51); p = 0.04]. Time to drug switch was accelerated (χ2 = 6.03, p = 0.01). No group differences in adverse events, disease activity, or self-reported outcomes were shown, indicating equally sustained remission.CONCLUSIONS: TDM reduced prescription of IFX, ETN, and ADA and identified patients benefiting from accelerated drug switch, thereby minimizing treatment failure, risk of toxicity, and unnecessary adverse events. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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