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“Getting the Dose Right”—Revisiting the Topic With Focus on Biologic Agents

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dc.contributor.authorMould, D.R.
dc.contributor.authorUpton, R.N.
dc.date.issued2024
dc.description.abstractNearly two decades after the Peck and Cross article '"Getting the dose right: facts, a blueprint, and encouragements" was published, a review of dose recommendations for biologics shows that the success in getting the dose right appears to have improved given the relatively low incidence of drug withdrawals and dosing/label changes. However, the clinical experience with monoclonal antibodies (MAbs) following approval has been less than perfect. In inflammatory diseases, the disease burden changes with time and high treatment failure rates have been reported. In addition, the use of concomitant steroids and immunosuppressant drugs with MAbs is common. These concomitant agents have their own safety issues and many immunosuppressant agents are not well-tolerated although they have been shown to reduce the incidence of anti-drug antibodies (ADA). This same complexity is seen in MAbs used in oncology as well, although with these agents the doses appear to be higher than needed, which results in high treatment costs and incidence of adverse events. Given the complexity of MAb pharmacokinetics, which makes providing a detailed description of dose options difficult, product labeling should include the options for alternative dose strategies and potentially include the use of therapeutic drug monitoring with dose individualization which have been shown to improve clinical response and reduce the incidence of ADA. So, while the recommended dosing for biologics seems improved over the issues noted 17 years ago, we still have some work to do.
dc.identifier.citationClinical Pharmacology and Therapeutics, 2024; 116(3):613-618
dc.identifier.doi10.1002/cpt.3285
dc.identifier.issn0009-9236
dc.identifier.issn1532-6535
dc.identifier.orcidUpton, R.N. [0000-0001-9996-4886]
dc.identifier.urihttps://hdl.handle.net/11541.2/38805
dc.language.isoen
dc.publisherWILEY
dc.rightsCopyright 2024 The Authors. Clinical Pharmacology & Therapeutics, American Society for Clinical Pharmacology and Therapeutics.
dc.source.urihttps://doi.org/10.1002/cpt.3285
dc.subjectHumans
dc.subjectImmunosuppressive Agents
dc.subjectBiological Products
dc.subjectAntibodies, Monoclonal
dc.subjectDrug Monitoring
dc.subjectDrug Labeling
dc.subjectDose-Response Relationship, Drug
dc.title“Getting the Dose Right”—Revisiting the Topic With Focus on Biologic Agents
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9916856230801831

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