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Lookup NU author(s): Professor Nick ReynoldsORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 The Author(s). Clinical and Translational Science published by Wiley Periodicals LLC on behalf of the American Society for Clinical Pharmacology and Therapeutics. Using a real-world psoriasis cohort, we established the pharmacokinetic-pharmacodynamic (PKPD) relationship for the biologic therapy adalimumab and evaluated the clinical utility and cost-effectiveness of a proactive therapeutic drug monitoring (TDM) strategy. A total of 543 patients on adalimumab monotherapy for psoriasis provided 946 pharmacokinetic samples and 1700 Psoriasis Area Severity Index (PASI) disease severity measurements. To describe the PASI change over time, a one-compartment linear PK model with first-order absorption and elimination was linked to a turnover mechanism of skin lesions. Based on the PKPD relationship and a predefined therapeutic range, real-time stochastic simulation was performed for a proactive TDM strategy, where trough levels guided dose escalation or reduction. Compared to the standard care, the TDM strategy improved PASI90 and PASI75 by 37.5% and 12.8%, respectively, with a 25.9% increase in drug costs. In the future, incorporating the PKPD model into a Bayesian therapeutic monitoring algorithm could facilitate individualized adalimumab dosing.
Author(s): Pan S, Tsakok T, Wei R, Dand N, Loeff FC, Bloem K, de Vries A, Baudry D, Duckworth M, Pushpa-Rajah A, Russell A, Alsharqi A, Becher G, Murphy R, Wahie S, Wright A, Griffiths CEM, Reynolds NJ, Barker J, Warren RB, Burden AD, Rispens T, Mahil SK, Standing JF, Smith CH
Publication type: Article
Publication status: Published
Journal: Clinical and Translational Science
Year: 2026
Volume: 19
Issue: 5
Print publication date: 01/05/2026
Online publication date: 30/04/2026
Acceptance date: 17/03/2026
Date deposited: 11/05/2026
ISSN (print): 1752-8054
ISSN (electronic): 1752-8062
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1111/cts.70563
DOI: 10.1111/cts.70563
PubMed id: 42057584
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