This clinically-oriented research focuses on the application, optimization and validation of therapeutic drug monitoring (TDM) of biologicals in children with Juvenile Idiopathic Arthritis (JIA) and non-infectious uveitis (NIU) .

The initial focus of this research was on optimization of the use of adalimumab ( an anti TNF alpha treatment) which has been shown to be effective in the treatment of JIA and NIU. Despite the high success rate, a proportion of patients do not achieve or remain in remission after treatment with adalimumab. This is possibly related to failure to achieve adequate trough levels, which are associated with clinical remission. The formation of antibodies to adalimumab (ADAs) is largely responsible for the failure to achieve an adequate trough level. In addition, ADAs are associated with shorter response duration and failure to respond. Although the literature advocates TDM of adalimumab, it is not yet routinely performed in clinical practice and there is no consensus on how and when to perform it as to what the therapeutic range is. What is certain is that both adalimumab levels and ADA’s provide insight into the effectiveness of therapy and allow therapy to be optimised at the individual level. The therapeutic options for JIA and NIU patients who fail on adalimumab are limited, so it is important to use these agents as optimally as possible. Based on TDM, we identified patients who were over- or under-treated. We defined a therapeutic range for adalimumab trough levels corresponding to an adequate clinical response in children with NIU. In addition, we focused on detecting and quantifying ADAs and correlating them with adalimumab trough levels and clinical response in a real-life setting in a large cohort of patients with JIA and NIU.

More recently, our research has expanded to include TDM with other biological therapies in children with JIA and NIU. We are also looking for alternative, child-friendly methods of sample collection in children via ‘dried blood spot’ sampling. The ultimate goal is to use TDM results to compose  a therapeutic algorithm for the treatment of JIA and NIU with biologicals, where dosing regimens can be adjusted based on TDM results and to introduce this into daily practice.