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

Abstract

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.

Oral Complementary Medicine Use among People with Inflammatory Arthritis: An Australian Rheumatology Association Database Analysis

“…Treatment for inflammatory arthritis depends on the type of disease, its symptoms, and severity. When indicated, conventional disease-modifying antirheumatic drugs (csDMARDs) and biologic/targeted synthetic DMARDs (b/tsDMARDs) are prescribed to slow or stop the progression of the disease and limit or prevent joint damage [5]. Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids are also sometimes indicated to manage pain and inflammation and may also have disease-modifying effects for some types of inflammatory arthritis [6,7].…”

Therapeutic drug monitoring of biopharmaceuticals in inflammatory rheumatic and musculoskeletal disease: a systematic literature review informing EULAR points to consider

“…Observational data have suggested a rationale for TDM of biopharmaceuticals by demonstrating large variations in serum concentrations between individuals on standard dosing, as well as a concentration–effect relationship 6–12. Although TDM has shown promise as a potential strategy to personalise treatment, several challenges remain and, in rheumatology, the use of TDM of biopharmaceuticals is still controversial 13 14. Randomised clinical trials addressing the effectiveness of TDM are lacking in rheumatology; hence, the clinical benefit and cost-effectiveness remain uncertain.…”

Homeopathic Medicine Reduces Pain and Hemarthrosis in Moderate and Severe Hemophilia: A Multicentric Study

“…However, this was not the primary objective of the study. The finding needs further exploration to see whether the natural history of this disease is modified under the influence of the homeopathic medicines in the same way as when allopathic doctors use disease-modifying drugs for rheumatoid arthritis [18]. …”