Proactive Therapeutic Drug Monitoring Based Adalimumab Therapy Optimization in Patients With Rheumatoid Arthritis

Boston Medical Center5 enrolled

Overview

Current standard of care of rheumatoid arthritis (RA) management includes a routine clinical assessment of disease activity to adjust therapy. For the most part, therapy adjustment for therapy non-response and/or suboptimal therapy response leads to therapy switch within the same class of therapy or to a different class of therapy. The lack of objective data to titrate dose of a given therapeutic agent for maximal possible efficacy makes it difficult for providers and payors to titrate dose as needed. Therapeutic drug monitoring (TDM) provides objective data for a proactive and individualized therapy optimization based on serum drug levels and the presence or absence of anti-drug antibodies. Maintaining optimal trough drug concentration is a proven concept of therapeutics. With respect to adalimumab, this approach helps to maximize therapeutic efficacy and prevent anti-adalimumab antibody development. However, lack of drug and disease state specific published data creates a barrier for a wider adoption of TDM into clinical practice. The objective of this single site, open label, randomized, parallel group pilot study is to investigate whether proactive therapeutic drug monitoring based adalimumab dose optimization results in higher rate of achieving and/or maintaining therapeutic goal compared to standard of care in patients with rheumatoid arthritis.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Rheumatoid Arthritis

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of rheumatoid arthritis * Starting or already being treated with standard dose adalimumab, 40 mg subcutaneously (SQ) every two weeks * Good medication adherence rate defined as Proportion of Days Covered (PDC) 80% and above Exclusion Criteria: * Detectable anti-adalimumab antibodies * Overlapping immune mediated diseases * Steroid therapy for more than 2 months prior to study enrollment * Poor medication adherence rate (PDC \< 80%) * History of recurrent infection resulting in therapy pause * Pregnant or lactating

Outcomes

Primary Outcomes

3 months change in proportion of patients with RA who achieve and maintain remission or low disease activity

Remission and low disease activity is defined as a Disease Activity Score-28 for Rheumatoid Arthritis with CRP (DAS28-CRP) score of \<2.6 and 2.6 -3.2 respectively. A DAS-28 reduction by 0.6 represents a moderate improvement, while a reduction more than 1.2 represents a major improvement.

Time frame: baseline, 3 months

6 months change in proportion of patients with RA who achieve and maintain remission or low disease activity

Time frame: baseline, 6 months

9 months change in proportion of patients with RA who achieve and maintain remission or low disease activity

Time frame: baseline, 9 months

12 months change in proportion of patients with RA who achieve and maintain remission or low disease activity

Time frame: baseline, 12 months

Secondary Outcomes

Percent of participants who achieved low or near remission disease severity

This will be assessed with the Routine Assessment of Patient Index Data 3 (RAPID3) which is a composite disease activity index consisting of the 3 Patient Reported Outcomes, disability, pain, and patient global assessment of disease activity. Scores can range from 0 to 30 and low or near remission disease severity is defined as patients with RAPID3 disease severity score of 3.1-6 and ≤3 respectively.

Time frame: baseline, 3 months, 6 months, 12 months