New paper highlights key areas in therapeutic drug monitoring for inflammatory rheumatic and musculoskeletal disease in clinical practice.
The results of a systematic literature review by the European Alliance of Associations for Rheumatology (EULAR) have been published, reporting the EULAR- endorsed overarching principles and points to consider.
BRC Deputy Director and Musculoskeletal Diseases theme lead Professor John Isaacs led a European consortium to develop guidance, informed by systematic literature reviews, on a relatively uncertain area of rheumatology practice. Professor Isaacs convened a multidisciplinary task force of 22 members from around Europe, to address the need for guidance around the use of therapeutic drug monitoring. The task force included patients, allied health professionals, trainees and practising rheumatologists.
Professor Isaacs commented:
We defined a number of unanswered questions concerning therapeutic drug monitoring (TDM) and the fellows performed systematic literature reviews informed by these questions. The evidence was presented to the task force and consensus “points to consider” (PtC) formulated (we felt there was insufficient evidence to produce formal guidance).
An important conclusion was that currently there are no prospective trials to decide whether TDM is effective or, indeed, cost effective. It is certainly expensive to perform because of additional blood tests plus the laboratory tests and their interpretation. Notwithstanding that, there are certain situations in which TDM might be considered as a useful adjunct to standard of care. For example, it may be useful to decide which drug to try next when a previously effective drug is failing. It may be also useful in the presence of certain side effects.
In 2019, NICE decided that TDM for rheumatoid arthritis should not be performed routinely and our up-to-date conclusions are consistent with this. However, our PtC also contain a research agenda to strengthen the evidence around TDM, which we hope will lead to future guidance and patient benefit.
For more information see full publication here: https://rmdopen.bmj.com/content/8/2/e002216