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Based on high drug levels, adalimumab can be tapered safely

Researchers from Reade Rheumatology and Sanquin Biologics have safely prolonged the dosing interval of adalimumab treated rheumatoid arthritis (RA) patients with drug levels higher than 8mg/L. Disease activity remained stable in spite of attenuated adalimumab levels.

Previously, researchers of the same groups demonstrated that higher concentrations correlate to an increased benefit to the patient. However, levels of adalimumab higher than 5 mg/L didn’t further increase clinical efficacy. Therefore, patients with concentrations higher than 8 mg/L were tapered, with the intention that trough levels would stay above 5mg/L. This study demonstrates that in clinical practice indeed tapering could be done safely.

For this open, randomized controlled trial, 26 patients who showed a stable adalimumab concentration above 8 mg/L were randomly assigned to continuation of adalimumab every other week (standard use), with 27 patients the dosage interval was prolonged to once every three weeks. Visits were scheduled at baseline, 13 and 26 weeks thereafter. 

After 28 weeks, in both groups mean ΔDAS28 had not altered indicating clinical efficacy remained similar in both groups. Adalimumab-treated RA patients with trough concentrations >8 mg/L can therefore prolong their standard dosing interval to once every three weeks without loss of disease control.

Publication

Successful reduction of overexposure in patients with rheumatoid arthritis with high serum adalimumab concentrations: an open-label, non-inferiority, randomised clinical trial. l'Ami MJ, Krieckaert CL, Nurmohamed MT, van Vollenhoven RF, Rispens T, Boers M, Wolbink GJ. Ann Rheum Dis. 2017 Sep 22. [Epub ahead of print]

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Last edited on: 28 September 2017