Personalised treatment using serum drug levels of adalimumab in patients with rheumatoid arthritis: an evaluation of costs and effects

Abstract

Tailoring biological treatment to individual patients with RA starting adalimumab using drug levels and short-term outcome is cost-effective. Results underscore the potential merit of personalised biological treatment in RA.

Cost-effectiveness of drug monitoring of anti-TNF therapy in inflammatory bowel disease and rheumatoid arthritis: a systematic review

“…Two were randomized controlled trials [14,18], and five used a modeling approach (three used a Markov model [16,17,19] and two a discrete event model [20,22]). Four studies included only CD patients [18][19][20]22], one included both CD and UC patients [14], and two only RA patients [16,17].…”

“…Two were randomized controlled trials [14,18], and five used a modeling approach (three used a Markov model [16,17,19] and two a discrete event model [20,22]). Four studies included only CD patients [18][19][20]22], one included both CD and UC patients [14], and two only RA patients [16,17]. Three studies compared the cost-effectiveness of the two strategies in patients with secondary IFX failure (dose-escalation strategy) [18][19][20]; one in patients in remission on optimized IFX (de-escalation strategy) [22]; one in patients starting adalimumab therapy [16]; and two in patients with clinical response to maintenance anti-TNF therapy [14,17].…”

“…Krieckaert et al [16] evaluated the cost-effectiveness of personalized treatment of RA using clinical response and serum adalimumab levels [16]. Outcomes were simulated using a patient-level Markov model.…”

“…The first study [16] evaluated the cost-effectiveness of a TDMbased strategy in RA patients starting adalimumab therapy compared with usual care. Disease activity was measured using the disease activity score for 28 joints (DAS28).…”

“…Although TC is related to a drug's efficacy and can be measured adequately, therapeutic drug monitoring (TDM) is not systematically incorporated into daily practice [16]. The systematic use of TDM and the detection of ADAs could be potentially beneficial and economically justified, especially given the high cost of biopharmaceuticals and the complexity of clinical decision-making [17].…”