Should anti-TNF-α drug levels and/or anti-drug antibodies be assayed in patients treated for rheumatoid arthritis?

摘要

For more than a decade, rheumatologists have been using biopharmaceutical agents against TNF-alpha. These monoclonal antibodies and fusion proteins have radically transformed the practice of rheumatology, most notably for patients with rheumatoid arthritis (RA). Considerable inter-individual variability in the clinical response to TNF-alpha antagonists has been documented. Researchers seeking to explain this variability have examined the potential role for the pharmacological properties and immunogenicity of these recombinant proteins. Over the last few years, academic and industrial laboratories have developed tools for monitoring serum drug concentrations (therapeutic drug monitoring [TDM]) and detecting anti-drug antibodies (ADAs) in clinical practice. Whether rheumatologists should use TDM and ADA assays in their everyday practice for their patients receiving TNF-a antagonists deserves discussion. Important questions include the evidence supporting the use of these tools, the best time for using them during the course of the treatment, whether ADAs should be looked for routinely, and whether there is sound evidence that TDM and ADA assays provide benefits to patients.