Drug monitoring consists of observing, recording or detecting the effects of a substance administered to an individual. Therapeutic drug monitoring (TDM) aims at improving patient care based on drug concentration measurement in order to adjust the dose or time interval individually.1 TDM is based on the assumption of a definable relation between dose and plasma/blood drug concentration and between concentration and therapeutic effects. In ARD , l’Ami et al conducted an open-label randomised trial comparing an increasing dosing interval of adalimumab from 2 to 3 weeks with a standard-dose conservative strategy in patients with rheumatoid arthritis (RA) with an adalimumab trough concentration >8 mg/L.2 The authors concluded that the dose tapering strategy was not inferior to the conservative strategy over 26 weeks. This important contribution is a step towards implementation of TDM in clinical practice. Prior to this work, the same group found that a drug concentration between 5 and 8 mg/L was associated with a good clinical response and strongly suggested that no additional improvement could be expected by increasing the dose (ie, by reducing the time interval) in patients with trough concentration >8 mg/L.3 A similar range has been described for adalimumab in psoriatic arthritis, which validates these findings.4 In the economic context, this tapering strategy can be seen as an opportunity to alleviate the burden for society. However, in the l’Ami et al ’s study, the target sample size was not reached, which somehow minimises the strength of the conclusion and raises the question of acceptability by patients to participate in the study. Indeed, some patients could have feared a flare or, more probably, because they wanted to taper the dose, did not want to be allocated to the conservative arm. Whatever this limitation, tapering adalimumab seems to perform as good as the recommended dose in patients with RA with …

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基于阿达木单抗浓度的递减策略：与推荐剂量一样好

药物监测包括观察、记录或检测给予个体的物质的影响。治疗药物监测 (TDM) 旨在根据药物浓度测量改善患者护理，以便单独调整剂量或时间间隔。 1 TDM 基于剂量与血浆/血液药物浓度之间以及浓度与药物浓度之间的可定义关系的假设。治疗效果。在 ARD 中，l'Ami 等人进行了一项开放标签随机试验，将阿达木单抗的给药间隔从 2 周增加到 3 周与标准剂量保守策略在阿达木单抗谷浓度 >8 mg 的类风湿关节炎 (RA) 患者中进行比较/L.2 作者得出结论，在 26 周内，逐渐减少剂量的策略并不逊色于保守策略。这一重要贡献是朝着在临床实践中实施 TDM 迈出的一步。在此工作之前，同一小组发现 5 至 8 mg/L 之间的药物浓度与良好的临床反应相关，并强烈建议通过增加剂量（即通过减少时间间隔）无法预期额外的改善在谷浓度 >8 mg/L 的患者中。3 阿达木单抗治疗银屑病关节炎的范围相似，这证实了这些发现。4 在经济背景下，这种逐渐减量的策略可以被视为减轻社会负担的机会. 然而，在 l'Ami 等人的研究中，没有达到目标样本量，这在某种程度上降低了结论的强度，并引发了患者参与研究的可接受性问题。确实，一些患者可能害怕突然发作，或者更可能是因为他们想逐渐减少剂量，不想分配到保守组。不管有什么限制，在 RA 患者中逐渐减量阿达木单抗似乎与推荐剂量一样好……