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. 2022 Aug 13;9(8):387.
doi: 10.3390/bioengineering9080387.

Long-Term Dose Optimization of Adalimumab via Dose Spacing in Patients with Psoriasis

Michael Benzaquen  1 , Mohammad Munshi  1 , Simon Bossart  1 , Laurence Feldmeyer  1 , Vladimir Emelianov  1 , Nikhil Yawalkar  1 , Simone Cazzaniga  1   2 , Kristine Heidemeyer  1
Affiliations

Long-Term Dose Optimization of Adalimumab via Dose Spacing in Patients with Psoriasis

Michael Benzaquen et al. Bioengineering (Basel). .

Abstract

Dose spacing (DS) can be useful for optimizing treatment with biologics in psoriasis patients. However, interval prolongation might increase the production of anti-drug antibodies (ADA) and, therefore, reduce the drug’s effectiveness. The long-term effects of DS with adalimumab in psoriatic patients have not been reported. The goal of our study was to evaluate the long-term follow-up of psoriatic patients after adalimumab DS regarding the clinical course and determination of circulating adalimumab, TNFα levels, and anti-adalimumab antibodies. We retrospectively included seven patients treated with adalimumab for moderate-to-severe psoriasis and benefiting from DS from 2010 to 2021. The dose interval of adalimumab was extended to three weeks for all patients and then to four weeks for three of the seven patients. Adalimumab trough levels, TNFα levels, and ADA against adalimumab were measured. For six of the seven patients, absolute PASI values remained below 3 throughout the follow-up period (median = 8.0 years; range: 1.7−11.5) after DS. All the patients were satisfied with the effectiveness of their treatment regime. Within the follow-up period, an average of 63 doses of adalimumab per patient were spared. The median adalimumab trough levels were 4.7 µg/mL (range: 1.9−12.5). TNFα levels remained under 10 pg/mL (undetectable) in all except one patient. ADA against adalimumab remained negative (<10 µg/mL) during the follow-up in all patients. Our data indicate that therapeutic drug monitoring, including the measurement of trough concentrations and ADA, together with the clinical response and patient’s preference, can be helpful for clinical decision making and treatment optimization in psoriasis.

Keywords: adalimumab; dose optimization; dose spacing; inflammatory skin diseases; long term; psoriasis.

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Conflict of interest statement

N.Y. has served as an investigator, speaker, and/or advisor for Abbvie. K.H. has served as an advisor for Abbvie. The other authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Adalimumab trough levels were measured after a median period of 18 months (range: 4–43) after starting DS. The blue line indicates the distribution median.
See this image and copyright information in PMC

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