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

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.