title: Is there potential for therapeutic drug monitoring of biologic agents in rheumatoid arthritis?
abstract: The use of biologics has significantly changed the management of rheumatoid arthritis over the last decade, becoming the cornerstone treatment for many patients. The current therapeutic arsenal consists of just under 10 biologic agents, with four different mechanisms of action. Several studies have demonstrated a large interindividual pharmacokinetic variability, which translates to unpredictability in clinical response among individuals. The present review focuses on the pharmacokinetics and pharmacodynamics of biologic agents approved for rheumatoid arthritis. The literature relating to their concentration-effect relationship and the use of pharmacokinetic-pharmacodynamic modelling to optimize drug regimens is analysed. Due to the scarcity and complexity of these studies, the current dosing strategy is based on clinical indexes/aspects. In general, dose individualization for biologics should be implemented increasingly in clinical practice as there is a direct benefit for treated rheumatoid arthritis patients. Moreover, there is an indirect benefit in terms of cost-effectiveness.
authors.affiliation: Pharmacy Department, Hospital Clinic Barcelona, Barcelona, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Bastida
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clinic Barcelona, Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Ruíz
authors.affiliation: Immunology Department, CDB, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain.
authors.forename: Mariona
authors.initials: M
authors.lastname: Pascal
authors.affiliation: Immunology Department, CDB, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Yagüe
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clinic Barcelona, Barcelona, Spain.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
authors.affiliation: Pharmacy Department, Hospital Clinic Barcelona, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Soy
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D001685:Biological Factors / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors
keywords: biologicals; monoclonal antibodies; pharmacokinetic-pharmacodynamic; rheumatoid arthritis; therapeutic drug monitoring