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Adalimumab

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== Medical Use and TDM ==
The drug is supplied as a solution for injection with a pH of 5.2. Current available dosage forms are 40 mg/0.8 mL, 40 mg/0.4 mL, 20 mg/0.4 mL and 10 mg/0.2 mL single-use prefilled syringe. There also exist prefilled pens of 40 mg/0.8 mL and 40 mg/0.4 mL.<ref name=”[4]”>Medsafe (2012). Humira solution for injection: Data Sheet. Accessed on 6 November 2018, at [http://www.medsafe.govt.nz/Medicines/SearchResult.asp ''http://www.medsafe.govt.nz/Medicines/SearchResult.asp''].</ref> It ADL is administered once every week or every other week. The target steady state trough concentration is between 5 and 8 µg/mL.
In current practices, a patient can be classified as a non-reponder, when the concentration of adalimumab is at a normal range, but the patient has no decreased disease activity, the patient can be classified as non-responding. A switch to a different medicine could be beneficialis often advised. When serum levels of adalimumab are too low, the underlying cause, either non-compliance or ADAb, is investigated. If the concentration is not extremely low, an increase of dosage can be considered.
Measurements of adalimumab levels are not routinely done. Therapeutic drug monitoring (TDM) is the practice of measuring the concentration of a specific drug in the bloodstream with the aim of using this data to optimize the individual dosing schemes of patients. TDM could provide a means to optimize the treatment with adalimumab. The introduction of a biosensor for adalimumab as a means for TDM would allow for better drug monitoring. It gives the possibility to detect non-responders in an early stage of treatment or to optimize dosing strategies. For patients with too high serum levels, dosage reduction to obtain serum levels between 5 and 8 µg/mL could be beneficial for the patient as the expensive drug is used more optimally. As ADAb can be the cause of the lower adalimumab serum levels, measurement of ADAb with a biosensor is also a possibility. However, as adalimumab can interfere with an assay that measures ADAb, measurement of adalimumab itself is to be prefered.<ref name=”[22]”>Pouw, M.F. et al. (2015). Key findings towards optimising adalimumab treatment: the concentration–effect curve. ''Annals of the rheumatic diseases, 74''(3), 513–518. [https://doi.org/10.1136/annrheumdis-2013-204172 ''doi:10.1136/annrheumdis-2013-204172'']</ref>

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