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Adalimumab and etanercept serum (anti)drug levels are not predictive for successful dose reduction or discontinuation in rheumatoid arthritis
  1. Noortje van Herwaarden1,
  2. Chantal A M Bouman1,
  3. Aatke van der Maas1,
  4. Ronald F van Vollenhoven2,
  5. Johannes W Bijlsma3,
  6. Frank H J van den Hoogen1,4,
  7. Alfons A den Broeder1,
  8. Bart J F van den Bemt5,6
  1. 1Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
  2. 2ClinTRID, Karolinska Institute, Stockholm, Sweden
  3. 3Department of Rheumatology & Clinical Immunology, Utrecht University Medical Centre, Utrecht, The Netherlands
  4. 4Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
  5. 5Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
  6. 6Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Noortje van Herwaarden, Department of Rheumatology, Sint Maartenskliniek, P.O. Box 9011, Nijmegen 6500 GM, The Netherlands; n.vanherwaarden{at}

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Tapering of TNF inhibitors (TNFi) is feasible in many patients with rheumatoid arthritis (RA), but sometimes leads to flaring. TNFi trough serum levels and antidrug antibodies (ADAs) have been proposed as predictors for successful dose reduction or discontinuation,1–3 suggesting that: (1) a patient with low or undetectable serum levels (with or without ADAs) should be able to successfully stop the TNFi and (2) a patient with high serum levels should be able to reduce the dose. As obtaining trough levels is often not practical, our aim was to investigate whether random timed serum drug levels and ADAs of adalimumab and etanercept are predictive for successful dose reduction or discontinuation of these TNFi in patients with RA doing well.

For these analyses 118 patients with RA from an open randomised clinical trial investigating a dose reduction strategy of adalimumab or etanercept with 18 months follow-up were included.4 Serum samples were collected at baseline (before start of dose reduction) at a regular visit, unrelated to time …

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