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A value proposition for trough level-based anti-TNFα drug dosing.

V Scharnhorst1, E M H Schmitz2, D van de Kerkhof3

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Therapeutic drug monitoring (TDM) for anti-tumor necrosis factor alpha (TNFα) therapy can personalize treatment for inflammatory bowel diseases and rheumatic disorders. Implementing TDM requires updated care pathways and stakeholder collaboration to improve patient outcomes and cost-effectiveness.

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Area of Science:

  • Immunology
  • Pharmacology
  • Clinical Chemistry

Background:

  • Anti-tumor necrosis factor alpha (TNFα) therapies for inflammatory bowel diseases and rheumatic disorders are costly, with variable patient response.
  • Therapeutic drug monitoring (TDM) offers a personalized approach to optimize anti-TNFα therapy.

Purpose of the Study:

  • To apply a value proposition framework to the use of TDM for anti-TNFα drugs.
  • To evaluate the evidence supporting TDM's cost-effectiveness and identify necessary adjustments in clinical care pathways.

Main Methods:

  • Utilized a value proposition framework to analyze TDM implementation for anti-TNFα therapy.
  • Described evidence for intervention effectiveness, cost-effectiveness, and proposed treatment algorithms.

Main Results:

  • Effective TDM requires drug level assays, target ranges, and anti-drug-antibody assays.
  • Optimizing TDM necessitates a shift from simple drug concentration reporting to TDM-based treatment algorithms.

Conclusions:

  • Maximizing TDM effectiveness in routine anti-TNFα therapy requires adapting current care pathways.
  • Successful TDM implementation depends on the collaborative efforts of laboratorians, pharmacists, and clinicians.