The drug adalimumab is used very successfully in the treatment of various inflammatory diseases. Yet in some patients, the efficacy of this drug decreases over time. We explain why this is so and how drug monitoring can contribute to long-term therapy success.
Whether for rheumatism, psoriasis, or chronic inflammatory bowel diseases: The drug adalimumab (ADM, trade name Humira®) has considerably improved the therapy options for many patients. As a human monoclonal antibody it is very effective and well tolerated. Like other so-called TNF-α blockers, adalimumab binds to the tumor necrosis factor-alpha (TNF-α), inhibiting its effect. The body therefore excretes fewer inflammation mediators, and the inflammation is ameliorated. Yet in some patients, adalimumab does not work, or its efficacy decreases over time. Sometimes a dosage increase helps in these cases. The cause for the loss of efficacy may also be that the body has formed antibodies against the drug—known as anti-drug antibodies (ADA). These antibodies neutralize the effect of adalimumab. In this case, the only remedy is to change the medication.
Therapeutic drug monitoring (TDM) can assist physicians in making the right therapy decision. Two tests are decisive in this regard: