title: Developing a Therapeutic Range of Adalimumab Serum Concentrations in Management of Psoriasis: A Step Toward Personalized Treatment.
abstract: OBJECTIVE
  Adalimumab has proven to be effective in suppressing psoriasis disease activity and is administered in a standard dose.
  
  
  OBJECTIVE
  To establish a therapeutic range for adalimumab trough levels in the treatment of plaque-type psoriasis, leading to a more personalized treatment.
  
  
  METHODS
  A multicenter, prospective, observational, daily practice cohort study conducted at an academic hospital with affiliated secondary care hospitals in Belgium (cohort 1) and 2 academic hospitals in the Netherlands (cohort 2). Both cohorts included adult patients treated with adalimumab for plaque-type psoriasis. Cohort 1 comprised 73 patients who were being treated with adalimumab for more than 24 weeks until 401 weeks. In cohort 2 (n = 62), serum samples were obtained between weeks 24 and 52 of treatment.
  
  
  METHODS
  Before the start of adalimumab therapy and at time of serum sampling, Psoriasis Area and Severity Index (PASI) scores were determined.
  
  
  METHODS
  Adalimumab trough level and PASI score at the time of serum sampling to determine the receiver-operator characteristics analyses and concentration effect curve.
  
  
  RESULTS
  By means of receiver-operator characteristics analyses with an area under the curve of 0.756 (SD, 0.046; 95% CI, 0.666-0.847) and a sensitivity of 78% and a specificity of 70%, 3.51 mg/L was established as the lower margin for the therapeutic range. By means of a concentration effect curve, 7 mg/L was established as the upper margin. One-third of patients had an adalimumab trough concentration exceeding 7 mg/L.
  
  
  CONCLUSIONS
  A therapeutic range of adalimumab trough levels of 3.51 mg/L to 7.00 mg/L, which corresponds to an optimal clinical effect, was identified. In one-third of patients, it was observed that trough concentrations exceeded the therapeutic window. Based on the established range, a therapeutic algorithm for adalimumab treatment for patients with psoriasis can be developed and validated in a prospective patient cohort. By identifying this range, a step has been taken toward a more rational use of biological therapy in psoriasis. Developing a therapeutic algorithm may lead to less overtreatment of patients and cost savings.
authors: Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Stef P
authors: SP
authors: Menting
authors: Department of Dermatology, Ghent University Hospital, Gent, Belgium.
authors: Emma
authors: E
authors: Coussens
authors: Jan van Breemen Research Institute/Reade, Amsterdam, the Netherlands4Sanquin Research and Landsteiner Laboratory, Department of Immunopathology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors: Mieke F
authors: MF
authors: Pouw
authors: Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Juul M P A
authors: JM
authors: van den Reek
authors: Department of Dermatology, Maria Middelares Hospital, Gent, Belgium.
authors: Linda
authors: L
authors: Temmerman
authors: Department of Dermatology, H Hart Ziekenhuis, Mol, Belgium.
authors: Hugo
authors: H
authors: Boonen
authors: Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Elke M G J
authors: EM
authors: de Jong
authors: Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Phyllis I
authors: PI
authors: Spuls
authors: Department of Dermatology, Ghent University Hospital, Gent, Belgium.
authors: Jo
authors: J
authors: Lambert
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000465:Algorithms; D000893:Anti-Inflammatory Agents / Q000097:blood / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000097:blood / Q000627:therapeutic use*; D001530:Belgium; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057285:Precision Medicine / Q000379:methods*; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab