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- Title
Developing a Therapeutic Range of Adalimumab Serum Concentrations in Management of Psoriasis: A Step Toward Personalized Treatment.
- Authors
Menting, Stef P; Coussens, Emma; Pouw, Mieke F; van den Reek, Juul M P A; Temmerman, Linda; Boonen, Hugo; de Jong, Elke M G J; Spuls, Phyllis I; Lambert, Jo
- Abstract
<bold>Importance: </bold>Adalimumab has proven to be effective in suppressing psoriasis disease activity and is administered in a standard dose.<bold>Objective: </bold>To establish a therapeutic range for adalimumab trough levels in the treatment of plaque-type psoriasis, leading to a more personalized treatment.<bold>Design, Setting, and Participants: </bold>A multicenter, prospective, observational, daily practice cohort study conducted at an academic hospital with affiliated secondary care hospitals in Belgium (cohort 1) and 2 academic hospitals in the Netherlands (cohort 2). Both cohorts included adult patients treated with adalimumab for plaque-type psoriasis. Cohort 1 comprised 73 patients who were being treated with adalimumab for more than 24 weeks until 401 weeks. In cohort 2 (n = 62), serum samples were obtained between weeks 24 and 52 of treatment.<bold>Interventions: </bold>Before the start of adalimumab therapy and at time of serum sampling, Psoriasis Area and Severity Index (PASI) scores were determined.<bold>Main Outcomes and Measures: </bold>Adalimumab trough level and PASI score at the time of serum sampling to determine the receiver-operator characteristics analyses and concentration effect curve.<bold>Results: </bold>By means of receiver-operator characteristics analyses with an area under the curve of 0.756 (SD, 0.046; 95% CI, 0.666-0.847) and a sensitivity of 78% and a specificity of 70%, 3.51 mg/L was established as the lower margin for the therapeutic range. By means of a concentration effect curve, 7 mg/L was established as the upper margin. One-third of patients had an adalimumab trough concentration exceeding 7 mg/L.<bold>Conclusions and Relevance: </bold>A therapeutic range of adalimumab trough levels of 3.51 mg/L to 7.00 mg/L, which corresponds to an optimal clinical effect, was identified. In one-third of patients, it was observed that trough concentrations exceeded the therapeutic window. Based on the established range, a therapeutic algorithm for adalimumab treatment for patients with psoriasis can be developed and validated in a prospective patient cohort. By identifying this range, a step has been taken toward a more rational use of biological therapy in psoriasis. Developing a therapeutic algorithm may lead to less overtreatment of patients and cost savings.
- Subjects
BELGIUM; NETHERLANDS; THERAPEUTIC use of monoclonal antibodies; ALGORITHMS; ANTI-inflammatory agents; LONGITUDINAL method; MONOCLONAL antibodies; PSORIASIS; QUESTIONNAIRES; TIME; TREATMENT effectiveness; SEVERITY of illness index; INDIVIDUALIZED medicine
- Publication
JAMA Dermatology, 2015, Vol 151, Issue 6, p616
- ISSN
2168-6068
- Publication type
journal article
- DOI
10.1001/jamadermatol.2014.5479