Rheumatology: Despite an association with clinical response, the use of biopharmaceutical blood concentrations to guide dosing is not recommended due to the lack of an identified optimal range in most indications (European Alliance of Associations for Rheumatology (EULAR))¹.

Dermatology: For drug monitoring in psoriasis a therapeutic window for Adalimumab of 3.5-7.0 µg/mL has been proposed. Therapeutic windows for use of anti-TNF inhibitors for other dermatological indications have not been identified².

Gastroenterology: Target trough levels for anti-TNF differ based on disease type, sampling time point (induction vs maintenance) and the target therapeutic outcome (e.g. clinical response vs endoscopic remission).

The below target concentrations are based on Cheifetz et al. (2021)³ and Feuerstein et al. (2017)⁴ and apply to intravenous Infliximab and subcutaneous Adalimumab in inflammatory bowel disease. All TDM thresholds are estimates based on population data. Results should always be interpreted in the context of the clinical situation.

Anti-drug antibodies <10 ng/mL: Not detected

Anti-drug antibodies ≥10 ng/mL: Present

Note, anti-drug antibody measurement is drug dependant. In the presence of drug levels ≥2.5 µg/mL, free anti-drug antibody cannot be accurately quantified and therefore its measurement is not indicated.

References:

1. Krieckaert et al, Ann Rheum Dis 2023; 82: 65-73.
2. Menting et al, JAMA 2015; 151: 616-22.
3. Cheifetz et al, Am J Gastroenterol 2021;116:2014-2025.
4. Feuerstein et al, Gastroenterology. 2017: 153(3):827-834.


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