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

V. Scharnhorst, E.M.H. Schmitz, D. van de Kerkhof, L.J.J. Derijks, M.A.C. Broeren

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Treatment of inflammatory bowel diseases and rheumatic disorders with anti-tumor necrosis factor alpha (TNFα) drugs is expensive, while a significant proportion of patients does not show adequate clinical response. Therapeutic drug monitoring (TDM) enables patient-specific anti-TNFα therapy. The role of laboratory tests in clinical care has recently been described in a value proposition framework. It describes care processes, stakeholders, costs, risks, benefits and patient outcomes based on the use of a laboratory test in a clinical care pathway. We have applied this concept to the use of TDM for anti-TNFα drugs, describing evidence that supports the intervention and its cost effectiveness, steps that need to be adjusted in the care pathway, possible treatment algorithms and measures to assess adoption of this framework into clinical practice. For effective TDM, an assay for measurement of drug levels together with appropriate target ranges and an anti-drug-antibody assay have to be implemented. Also, instead of only reporting the drug concentration, laboratorians, pharmacists and clinicians should deliver added value by introducing a TDM-based treatment algorithm into clinical practice. Thus, to maximize effectiveness of TDM of anti-TNFα therapy in routine care, adjustment of current care pathways and cooperation of many stakeholders are needed.

LanguageEnglish
Pages89-95
Number of pages7
JournalClinica Chimica Acta
Volume489
DOIs
StatePublished - 1 Feb 2019

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Drug Monitoring
Pharmaceutical Preparations
Cost-Benefit Analysis
Therapeutics
Critical Pathways
Monitoring
Inflammatory Bowel Diseases
Pharmacists
Anti-Idiotypic Antibodies
Assays
Tumor Necrosis Factor-alpha
Patient monitoring
Cost effectiveness
Antibodies

Cite this

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A value proposition for trough level-based anti-TNFα drug dosing. / Scharnhorst, V.; Schmitz, E.M.H.; van de Kerkhof, D.; Derijks, L.J.J.; Broeren, M.A.C.

In: Clinica Chimica Acta, Vol. 489, 01.02.2019, p. 89-95.

Research output: Contribution to journalArticleAcademicpeer-review

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