Adalimumab in Psoriasis: How Much Is Enough?

Abstract

Biologic therapies targeting tumor necrosis factor have revolutionized treatment of immune-mediated inflammatory diseases such as psoriasis, but optimal dosing and appropriate use of therapeutic drug monitoring are not yet fully understood. Wilkinson et al. explore these questions in a real-world psoriasis cohort on adalimumab monotherapy, defining a therapeutic range and finding value in early measurement for predicting clinical response.

Figure 1.. Speculative framework for biologic therapeutic drug monitoring in psoriasis.

This was conceptually adapted from conditional recommendations in the field of inflammatory bowel disease (IBD) (Feuerstein et al., 2017). The value of proactive testing is still under debate. Therapeutic ranges appear to be similar across immune-mediated inflammatory diseases including IBD, suggesting shared pharmacodynamics. Much remains to be determined, including timing of monitoring, i.e., during induction or at steady-state, and whether particular subgroups of psoriasis patients exist who may require higher target doses (^§). Increasing the dose may also include decreasing the dosing interval or adding an immunomodulator. * Mechanistic failure. ^† Immune-mediated pharmacokinetic failure; transition to another class of drug is also reasonable. ^‡ Non–immune-mediated pharmacokinetic failure. ADAs, anti-drug antibodies; vs., versus.