QEUH Infliximab and Adalimumab Service
Since Monday 11th December 2017, the Adalimumab and Infliximab service is provided by the Biochemistry department at the Queen Elizabeth University hospital. We measure these drugs using an immunoassay based method from Promonitor.
The antidrug antibody for both measurements are more complex. There is debate as to whether total anti-drug antibody or free anti-drug antibody is better. In light of this, we will report Immundiagnostik total anti-drug antibody concentrations – i.e. identical to Exeter’s current reported method. In those who have increased levels, a second Promonitor free antidrug antibody will be performed.
Initial work on several hundred samples has shown that the free antidrug assay picks up far fewer positive cases (<25%). Where the drug level is lower, there is a good case to increase the biological agent and correlate clinical response with a further repeat sample later. Over the first few months, the information will be collated as we would seek clinical feedback.
Thereafter, we will be looking at other biological agents especially Etanercept if there are adequate requests.
Vedolizumab drug level and antibody testing
We are pleased to confirm that vedolizumab drug level testing is now available. The utility of testing drug and anti-drug antibodies for vedolizumab has yet to be fully ascertained. Target drug levels for vedolizumab have not been clearly established. The current evidence is covered in these articles:-
https://www.sciencedirect.com/science/article/pii/S1542356518304026
https://doi.org/10.1093/ecco-jcc/jjz041
https://dx.doi.org/10.1186%2Fs12916-019-1323-8
Vedolizumab testing is not part of the nationally commissioned TDM service. The cost per sample is £20.
In order to gather clinical data regarding the benefits of vedolizumab drug level testing, please complete and enclose a completed request form with each sample. This information will be used to try and secure UKAS accreditation for vedolizumab drug level testing.
Complete clinical details to enable audit of these new assays are essential. In NHSGGC Trakcare will shortly be updated to enable these detailed to be entered.
Paper forms to provide relevant details as a supplement to the request have been produced:
Specific Rheumatology guidance on monitoring has been produced:
Specific Gastroenterology guidance on monitoring has been produced, along with a quick reference guide:
Gastroenterology Quick Reference Guide
Further Information
For queries about the service please contact the QEUH Biochemistry Laboratory on 0141 354 9060
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