Adalimumab Drug Level, Trough Adalimumab, HUMIRA, Anti TNF Alpha

Immunology

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Description

TNF alpha is a pro-inflammatory cytokine that is involved in establishing and sustaining inflammatory reactions. Adalimumab is a monoclonal antibody directed towards TNF alpha [1]. It is a useful biological therapy for chronic inflammatory conditions such as Crohns disease, chronic psoriasis and rheumatic diseases [1,2,3]. Adalimumab inhibits the production of TNF alpha, therefore leading to a reduction in disease symptoms [1,2,4]. The therapeutic effect of the drug depends upon circulating levels in the blood stream. Monitoring trough drug levels whilst establishing a dose regime can aid in determining if a therapeutic level (3-7mg/L) has been reached. Reduced trough levels (<3mg/L) may be due to insufficient dosing or due to the development of anti-drug antibodies (ADAs) which prevent the drug from working effectively. It is recommended that ADAs be measured if the trough Adalimumab level is <3mg/L or if an adverse reaction is observed post infusion. Supratherapeutic trough levels (>7mg/L) indicate that Adalimumab has been given at a higher dose than required in that patient.

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Indications

Monitoring trough Adalimumab levels.

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Sample Type

Serum (Gel 5ml Yellow) or Plasma (2mL EDTA).
Requests from outside Sheffield: transport at ambient temperature via Royal Mail or Courier.

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Reference Range

Suboptimal trough level: <3mg/L.
Therapeutic trough level: 3-7mg/L.
Supratherapeutic trough level: >7mg/L.

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Turnaround Time

Within 10 days

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Testing Frequency

As required

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References

Tracey D, et al. Tumor necrosis factor antagonist mechanisms of action: A comprehensive review. Pharmacology and Therapeutics. 2008. 117: 244-279. [Ref 1].
Mayzor Y, et al. Adalimumab drug and antibody levels as predictors of clinical and laboratory response in patients with Crohn's disease. Alimentary Pharmacology and Therapeutics. 2014. 40:620-628. [Ref 2].
Bradley JR. TNF-mediated inflammatory disease. J Pathol 214: 149-160. [Ref 3].
Bender NK, et al. Immunogenicity, efficacy and adverse effects of adalimumab in RA patients. Rheumatol Int. 27: 269-274. [Ref 4].

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See Also

Adalimumab Antibodies

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