Efficacy, safety, and cost-effectiveness of therapeutic drug monitoring (TDM) for TNF inhibitor therapy in rheumatic disease: A systematic review and meta-analysis
Pooled result · Treat-to-target rates (response prediction)Result — go to the resultRelative risk 1.30 95 % CI 1.02–1.65Authors' conclusion
TDM-guided TNFi therapy was associated with increased rates of low disease activity and decreased risks of relapse, and may save cost compared with empirical-guided therapy in patients with rheumatic disease.
Study context
- Population
- Patients with rheumatic disease treated with TNFi14 studies (8 RCTs, 6 cohort)
- Participants
- 2,427 patients
- Comparison
- TDM-guided TNFi therapy vs empirical-guided therapy
- Outcome
- Treat-to-target rates (response prediction)
Pooled result
As reported in the abstract
Relative risk
1.30
95 % CI 1.02–1.65
P = 0.03
TDM-guided TNFi therapyvs Empirical-guided therapy
RR 1.30 (95 % CI 1.02–1.65); P = 0.03
Further pooled results
| Outcome | RR (95 % CI) | P value | |
|---|---|---|---|
| Low disease activity rates (response prediction)TDM-guidedvs Empirical-guidedI2=61 % | 2.11 (1.22–3.66) | P = 0.007 | |
| Relapse rates (dose reduction prediction), TDM-guidedvs empirical-guided dose reductionI2=0 % | 0.73 (0.65–0.82) | P < 0.00001 | |
| TDM-guided dose reductionvs standard-dosing therapy: no differenceI2=57 % | 1.24 (0.85–1.80) | P = 0.27 | |
| 0.20.5125Relative risk (log scale) |
Clinical remission rates (response prediction): no difference
- No difference in clinical remission rates
TDM-guided dose reduction vs standard-dosing therapy: no difference
- No difference between TDM-guided dose reduction and standard-dosing therapy
Change in disease activity score, mean disease activity score, radiographic progression
- No significant difference
Cost per patient per year
- TDM-guided therapy associated with reduced cost per patient per year
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Efficacy, safety, and cost-effectiveness of therapeutic drug monitoring (TDM) for TNF inhibitor therapy in rheumatic disease: A systematic review and meta-analysis. Semin Arthritis Rheum. Published 4 November 2023. doi:10.
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