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Optimising Therapeutic Intervals for Anti-TNF Biologics in Rheumatoid Arthritis: A Retrospective Real-World Study
Jose Manuel Dodero-Anillo1,2, Manuel Rosety-Rodriguez2, Maria Jose Pedrosa-Martinez1
1Clinical Pharmacology, Hospital Universitario Puerto Real, 11510 Cadiz, Spain.
Life (Basel, Switzerland)
|May 27, 2026
Summary
Therapeutic drug monitoring for anti-TNF biologics in rheumatoid arthritis (RA) needs adjustment. Lowering current therapeutic ranges improves identifying treatment responders, especially for infliximab and adalimumab.
Area of Science:
- Rheumatology
- Pharmacology
- Immunology
Background:
- Therapeutic drug monitoring (TDM) of anti-TNF biologics is crucial for optimizing rheumatoid arthritis (RA) treatment.
- Current therapeutic ranges for anti-TNF drugs may not accurately reflect clinical response in routine practice.
Purpose of the Study:
- To evaluate the effectiveness of current and proposed therapeutic ranges for anti-TNF drugs in RA patients.
- To assess the association between drug levels, anti-drug antibodies, and clinical response (DAS28).
Main Methods:
- Retrospective observational study of 224 RA adults treated with infliximab (IFX), adalimumab (ADL), or etanercept (ETN).
- Measurement of drug and anti-drug antibody levels using ELISA.
- Analysis of associations between drug levels, antibodies, and DAS28 scores.
Main Results:
- Drug levels were significantly associated with treatment response (p < 0.001).
- Anti-drug antibodies correlated with non-response, particularly for IFX and ADL.
- Lowering proposed therapeutic ranges significantly improved sensitivity in identifying responders.
Conclusions:
- Current anti-TNF therapeutic ranges have limited utility in identifying RA responders in real-world settings.
- Adjusting lower bounds of therapeutic ranges enhances TDM individualization for IFX and ADL.
- Prospective validation is recommended for proposed lower therapeutic ranges.
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