Effect of Therapeutic Drug Monitoring vs Standard Therapy During Infliximab Induction on Disease Remission in Patients With Chronic Immune-Mediated Inflammatory Diseases: A Randomized Clinical Trial
RCT (n=411) found dose adjusted infliximab (according to drug and drug antibody levels) did not increase clinical remission rates at week 30 vs conventional infliximab across a range of autoimmune inflammatory conditions (53.0% vs 50.5% respectively, p=0.78).
Source:
Journal of the American Medical Association
SPS commentary:
A separate study investigating dose reducing conventional DMARDs in stable rheumatoid arthritis found that halving the dose increased the rate of disease flares over 12 months vs continued stable dose (25% vs 6% had flares, difference 18%, 95%CI 7% to 29%) and non-inferiority was not demonstrated.
A related editorial comments on these studies, concluding that they provide important, clinically useful data on the treatment of diseases requiring immunomodulatory therapies. The results suggest that therapeutic drug monitoring for patients with immune-mediated inflammatory diseases, and routine DMARD dose reduction for patients with rheumatoid arthritis in remission, are not advisable for everyone. However, a subset of patients may benefit from these therapeutic approaches.