Monitoring Drug and Antidrug Levels: A Rational Approach in Rheumatoid Arthritis Patients Treated with Biologic Agents Who Experience Inadequate Response While Being on a Stable Biologic Treatment

Author:

Mazilu Diana12,Opriş Daniela12,Gainaru Cecilia2,Iliuta Mihaela2,Apetrei Natalia3,Luca Giorgiana4,Borangiu Andreea12,Gudu Tania1,Peltea Alexandra1,Groseanu Laura12,Constantinescu Cosmin12,Saulescu Ioana12,Bojinca Violeta12,Balanescu Andra12,Predeteanu Denisa12,Ionescu Ruxandra12

Affiliation:

1. Department of Rheumatology and Internal Medicine, “Sfanta Maria” Hospital, Bulevardul Ion Mihalache nr 37-39, 011172 Bucharest, Romania

2. “Carol Davila” University of Medicine, Bucharest, Romania

3. Biology Faculty, Bucharest University, Bucharest, Romania

4. Biology Faculty, “Alexandru Ioan Cuza” University, Iasi, Romania

Abstract

Clinical response in patients with rheumatoid arthritis (RA) treated with biologic agents can be influenced by their pharmacokinetics and immunogenicity. The present study evaluated the concordance between serum drug and antidrug levels as well as the clinical response in RA patients treated with biological agents who experience their first disease exacerbation while being on a stable biologic treatment. 154 RA patients treated with rituximab (RTX), infliximab (IFX), adalimumab (ADL), or etanercept (ETN) were included. DAS28, SDAI, and EULAR response were assessed at baseline and reevaluated at precise time intervals. At the time of their first sign of inadequate response, patients were tested for both serum drug level and antidrug antibodies level. At the next reevaluation, patients retreated with RTX that had detectable drug level had a better EULAR response (P=0.038) with lower DAS28 and SDAI scores (P=0.01andP=0.03). The same tendency was observed in patients treated with IFX and ETN regarding EULAR response (P=0.002andP=0.023), DAS28 score (P=0.002andP=0.003), and SDAI score (P=0.001andP=0.026). Detectable biologic drug levels correlated with a better clinical response in patients experiencing their first RA inadequate response while being on a stable biologic treatment with RTX, IFX, and ETN.

Publisher

Hindawi Limited

Subject

General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology,General Medicine

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