JCM, Vol. 13, Pages 451: Therapeutic Drug Monitoring in Patients with Systemic Lupus Erythematosus: Utility and Gaps

JCM, Vol. 13, Pages 451: Therapeutic Drug Monitoring in Patients with Systemic Lupus Erythematosus: Utility and Gaps

Journal of Clinical Medicine doi: 10.3390/jcm13020451

Authors: Kar Mun Chong He Jiang Elaine Ah Gi Lo Wei-Zhen Hong Emmett Tsz-Yeung Wong Gek Cher Chan Jiacai Cho

Despite advances in the treatment of patients with systemic lupus erythematous (SLE), outcomes have remained suboptimal. Persistent disease activity, patient comorbidities and drug toxicities contribute to the accrual of progressive irreversible damage and high rates of morbidity and mortality. Currently, similar drug doses and regimens are promulgated in the treatment guidelines for all SLE patients, despite the vast differences in patient and environmental factors that affect the drugs’ metabolism and blood concentrations. This causes a disconnect between drug dosing and drug blood concentrations, which can then result in unpredictability in drug toxicities and therapeutic effects. In this review, we discuss commonly used oral immunosuppressive medications in SLE, their pharmacogenomics, and factors affecting their metabolism and blood concentrations. Further, we highlight the role of therapeutic drug monitoring in SLE, which is the first accessible step to individualising therapy.