28 June 2023
BSTOP study findings show that blood tests to measure adalimumab concentration may help people with psoriasis.
Psoriasis occurs when the immune system becomes overactive. Dermatologists can treat more severe psoriasis with a class of medication called ‘biologics’. One such medication is adalimumab. It blocks a chemical ‘messenger’ called TNFto dampen the overactive immune response. However, this treatment only benefits between 5 and 8 of every 10 people with psoriasis.
We know from our research that a blood test to measure the concentration of adalimumab can predict how well the treatment will work. However, using this test to improve treatment response is not yet part of routine psoriasis care.
In this study we used the ‘RE-AIM’ framework to help overcome some of the challenges of introducing a new test into routine healthcare. ‘RE-AIM’ stands for Reach, Effectiveness, Adoption, Implementation and Maintenance. First, we developed an algorithm to standardise how doctors and nurses use and interpret adalimumab blood test results to inform treatment decisions based on an evidence review and multi-disciplinary expert opinion. Next, we embedded the test request, result, and interpretation into the electronic healthcare record, made the algorithm available via the Trust’s online guideline portal, and trained all clinic staff.
Over 5 months, 170 of 229 (74%) patients taking adalimumab for psoriasis had adalimumab blood tests performed. All clinic staff were willing to adopt the protocol to guide treatment changes. This improved psoriasis in 17 of 19 (89%) patients who were failing adalimumab treatment. 4 of 5 individuals (80%) with clear skin successfully reduced their dose of adalimumab following the blood test, and they still had clear skin nearly 1 year later. The blood tests and algorithm are maintained as part of routine psoriasis care 2 years later.
This study serves as a template for other centres to improve psoriasis care using blood tests that measure adalimumab concentration. Other similar initiatives to advance routine healthcare and save NHS costs may benefit from the steps used in the ‘RE-AIM’ framework.
See the full scientific paper here.