Evaluation of a Therapeutic Drug Monitoring Strategy for Adalimumab in Psoriasis: A Prospective Pharmacokinetic‐Pharmacodynamic Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Using a real-world psoriasis cohort, we established the pharmacokinetic-pharmacodynamic (PKPD) relationship for the biologic therapy adalimumab and evaluated the clinical utility and cost-effectiveness of a proactive therapeutic drug monitoring (TDM) strategy. A total of 543 patients on adalimumab monotherapy for psoriasis provided 946 pharmacokinetic samples and 1700 Psoriasis Area Severity Index (PASI) disease severity measurements. To describe the PASI change over time, a one-compartment linear PK model with first-order absorption and elimination was linked to a turnover mechanism of skin lesions. Based on the PKPD relationship and a predefined therapeutic range, real-time stochastic simulation was performed for a proactive TDM strategy, where trough levels guided dose escalation or reduction. Compared to the standard care, the TDM strategy improved PASI90 and PASI75 by 37.5% and 12.8%, respectively, with a 25.9% increase in drug costs. In the future, incorporating the PKPD model into a Bayesian therapeutic monitoring algorithm could facilitate individualized adalimumab dosing.
DOI: 10.1111/cts.70563
Authors: Shan Pan, Teresa Tsakok, Ruoheng Wei, Nick Dand, Floris C. Loeff, Karien Bloem, Annick de Vries, David Baudry, Michael Duckworth, Angela Pushpa‐Rajah, Alice Russell, Ali Alsharqi, Gabrielle Becher, Ruth Murphy, Shyamal Wahie, Andrew Wright, Christopher E. M. Griffiths, Nick J. Reynolds, Jonathan Barker, Richard B. Warren, A. David Burden, Theo Rispens, Satveer K. Mahil, Joseph F. Standing, Catherine H. Smith, the BADBIR Study Group
Institutions: Guy's and St Thomas' NHS Foundation Trust, King's College London, Sanquin, Royal Liverpool and Broadgreen University Hospital NHS Trust, Broadgreen Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, University Hospital of North Durham, University of Bradford, University of Manchester, King's College Hospital, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, NIHR Newcastle Biomedical Research Centre, Newcastle University, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Northern Care Alliance NHS Foundation Trust, University of Glasgow, UCL School of Pharmacy, University College London
Language: English
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,630
OpenAlex ID: W7158474126
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