A recent study investigated the barriers rheumatologists faced in adopting therapeutic drug monitoring for tumor necrosis factor-α inhibitors in the treatment of rheumatoid arthritis. Therapeutic drug monitoring involves measuring drug levels and anti-drug antibodies to optimize treatment outcomes, but its implementation in routine clinical practice had been hindered by several factors.

The objective of the study, published in Rheumatology Advances in Practice, was to explore the perceived barriers that might have prevented the widespread adoption of tumor necrosis factor-α inhibitors (TNFi) therapeutic drug monitoring (TDM). Researchers conducted semi-structured telephone interviews with 11 senior rheumatologists experienced in managing RA. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic framework analysis to identify barriers to TNFi TDM adoption.

The analysis revealed five primary barriers:

1. Perceived Clinical Need: Rheumatologists reported a lack of observed clinical necessity for TDM in their routine practice, suggesting that current management strategies were sufficient.
2. Understanding of Testing Benefits: There was variability in understanding how TDM could have improved clinical practice, with some rheumatologists expressing skepticism about its added value.
3. Insufficient Clinical Evidence: The absence of robust clinical evidence supporting the effectiveness of TDM was a significant barrier, highlighting the need for more research.
4. Resource Constraints: Financial and logistical limitations were cited as obstacles to incorporating TDM into standard practice, including funding and reimbursement issues.
5. Technical Capability: Some rheumatologists noted that their institutions had lacked the necessary infrastructure to perform TDM, such as access to specialized laboratories and trained personnel.

The researchers emphasized that multiple barriers impeded the adoption of TNFi TDM in routine clinical practice and suggested that overcoming these barriers could have involved collaborative efforts among stakeholders.

"TNFi TDM has the potential to improve health outcomes for rheumatoid arthritis (RA). Yet rheumatologists perceived barriers to measuring drug levels and anti-drug antibodies routinely which may have limited the scope for TDM to become standard of care," concluded the researchers.

The study's findings underscored the need for further research to demonstrate the clinical utility and cost-effectiveness of TNFi TDM, as well as educational initiatives to improve understanding of its potential benefits among rheumatologists. Addressing resource constraints and technical limitations would also have been crucial for widespread adoption.

As the rheumatology community worked towards optimizing RA management, overcoming the identified barriers to TNFi TDM adoption would have been an important step in improving patient outcomes and advancing the standard of care.

Full disclosures could be found in the study.