Evaluation of a Therapeutic Drug Monitoring Strategy for Adalimumab in Psoriasis: A Prospective Pharmacokinetic‐Pharmacodynamic Study

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.

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Publication Details

Journal
Clinical and Translational Science
Published
2026-04-30
DOI
https://doi.org/10.1111/cts.70563
Primary Topic
Psoriasis: Treatment and Pathogenesis
Type
article
Field-Weighted Citation Impact
0.00
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article

Evaluation of a Therapeutic Drug Monitoring Strategy for Adalimumab in Psoriasis: A Prospective Pharmacokinetic‐Pharmacodynamic Study

Floris C. Loeff, A de Vries, C S Smith, G Becher et al.
Clinical and Translational Science
Psoriasis: Treatment and Pathogenesis
article

Evaluation of a Therapeutic Drug Monitoring Strategy for Adalimumab in Psoriasis: A Prospective Pharmacokinetic‐Pharmacodynamic Study

Floris C. Loeff, A de Vries, C S Smith, G Becher, Ali Alsharqi, Angela Pushpa‐Rajah, Theo Rispens, Ruth Murphy, Karien Bloem, Joseph Frank Standing, N Dand, Shyamal Wahie, Michael Duckworth, Teresa Tsakok, Shan Pan, Christopher E M Griffiths, Richard B Warren, Ruoheng Wei, Andrew Wright, Alice Russell, Nick J Reynolds, David Baudry, A David Burden, Satveer K Mahil, Jonathan Barker, the BADBIR Study Group
article en

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.

Clinical and Translational ScienceVol. 19(5)
Nottingham University Hospitals NHS Trust (GB), University of Bradford (GB), King's College London (GB), Guy's and St Thomas' NHS Foundation Trust (GB), Manchester Academic Health Science Centre (GB), University Hospital of North Durham (GB), Newcastle upon Tyne Hospitals NHS Foundation Trust (GB), Royal Liverpool and Broadgreen University Hospital NHS Trust (GB), University of Manchester (GB), Sanquin (NL), Northern Health and Social Care Trust (GB), Glasgow Life (GB), NIHR Newcastle Biomedical Research Centre (GB), Queen's Medical Centre (GB), King's College Hospital (GB), NIHR Manchester Biomedical Research Centre (GB), Institute of Infection and Immunity (CA), University College London (GB), Newcastle University (GB)
Good health and well-being
Openalex Percentile: Top 14%
Psoriasis: Treatment and Pathogenesis
DOIOpen Access PDFOpenAlex
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