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Editorial
December 21, 2021

Therapeutic Drug Monitoring for Immune-Mediated Inflammatory Diseases

Author Affiliations
  • 1Division of Rheumatology, Allergy, and Immunology and Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA. 2021;326(23):2370-2372. doi:10.1001/jama.2021.21315

Biologic disease-modifying antirheumatic drugs (bDMARDs) have transformed the care of patients with immune-mediated inflammatory diseases, characterized by common inflammatory pathways leading to inflammation, such as rheumatoid arthritis, spondyloarthritis, and inflammatory bowel disease. Biologic DMARDs improve symptoms and reduce structural damage of joints, the gastrointestinal tract, and other affected organs. Biologic DMARDs reduce disability, comorbidities, and mortality.1 However, many patients do not respond to treatment, and approximately 50% of initial responders subsequently have inadequate disease control, defined as secondary failure.2 Preventing secondary failure is an important therapeutic goal because disease flares are associated with irreversible tissue damage, glucocorticoid exposure, lost productivity, and worsened quality of life. Furthermore, it may take weeks to months to reestablish disease control after secondary failure.

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