{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:11:56Z","timestamp":1787962316126,"version":"build-2784847793"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR130580"],"award-info":[{"award-number":["NIHR130580"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014653","name":"NIHR Manchester Biomedical Research Centre","doi-asserted-by":"publisher","award":["NIHR203308"],"award-info":[{"award-number":["NIHR203308"]}],"id":[{"id":"10.13039\/100014653","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There is no evidence base to support the use of 6-monthly monitoring blood tests for the early detection of liver, blood and renal toxicity during established anti-tumour necrosis factor alpha (TNF\u03b1) treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the incidence and risk factors of anti-TNF\u03b1 treatment cessation owing to liver, blood and renal side-effects, and to estimate the cost-effectiveness of alternate intervals between monitoring blood tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A secondary care-based retrospective cohort study was performed. Data from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) were used. Patients with at least moderate psoriasis prescribed their first anti-TNF\u03b1 treatment were included. Treatment discontinuation due to a monitoring blood test abnormality was the primary outcome. Patients were followed-up from start of treatment to the outcome of interest, drug discontinuation, death, 31 July 2021 or up to 5\u2005years, whichever came first. The incidence rate (IR) and 95% confidence intervals (CIs) of anti-TNF\u03b1 discontinuation with monitoring blood test abnormality was calculated. Multivariate Cox regression was used to examine the association between risk factors and outcome. A mathematical model evaluated costs and quality-adjusted life years (QALYs) associated with increasing the length of time between monitoring blood tests during anti-TNF\u03b1 treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The cohort included 8819 participants [3710 (42.1%) female, mean (SD) age 44.76 (13.20) years] that contributed 25 058 person-years (PY) of follow-up and experienced 125 treatment discontinuations owing to a monitoring blood test abnormality at an IR of 5.85 (95% CI 4.91\u20136.97)\/1000 PY. Of these, 64 and 61 discontinuations occurred within the first year and after the first year of treatment start, at IRs of 8.62 (95% CI 6.74\u201311.01) and 3.44 (95% CI 2.67\u20134.42)\/1000 PY, respectively. Increasing age (in years), diabetes and liver disease were associated with anti-TNF\u03b1 discontinuation after a monitoring blood test abnormality [adjusted hazard ratios of 1.02 (95% CI 1.01\u20131.04), 1.68 (95% CI 1.00\u20132.81) and 2.27 (95% CI 1.26\u20134.07), respectively]. Assuming a threshold of \u00a320 000 per QALY gained, no monitoring was most cost-effective, but all extended periods were cost-effective vs. 3- or 6-monthly monitoring.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Anti-TNF\u03b1 drugs were uncommonly discontinued owing to abnormal monitoring blood tests after the first year of treatment. Extending the duration between monitoring blood tests was cost-effective. Our results produce evidence for specialist society guidance to reduce patient monitoring burden and healthcare costs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjd\/ljad430","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T20:48:19Z","timestamp":1699303699000},"page":"559-564","source":"Crossref","is-referenced-by-count":8,"title":["Discontinuation of anti-tumour necrosis factor alpha\u00a0treatment owing to blood test abnormalities, and cost-effectiveness of alternate blood monitoring strategies"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0121-4919","authenticated-orcid":false,"given":"Abhishek","family":"Abhishek","sequence":"first","affiliation":[{"name":"Academic Rheumatology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D","family":"Stevenson","sequence":"additional","affiliation":[{"name":"School of Health and Related Research, University of Sheffield , Sheffield , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3859-7354","authenticated-orcid":false,"given":"Georgina","family":"Nakafero","sequence":"additional","affiliation":[{"name":"Academic Rheumatology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew\u00a0J","family":"Grainge","sequence":"additional","affiliation":[{"name":"Lifespan and Population Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Evans","sequence":"additional","affiliation":[{"name":"BADBIR, University of Manchester , Manchester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oras","family":"Alabas","sequence":"additional","affiliation":[{"name":"BADBIR, University of Manchester , Manchester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Card","sequence":"additional","affiliation":[{"name":"Lifespan and Population Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten W","family":"Taal","sequence":"additional","affiliation":[{"name":"Centre for Kidney Research and Innovation, Translational Medical Sciences, University of Nottingham , Derby , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guruprasad P","family":"Aithal","sequence":"additional","affiliation":[{"name":"Nottingham Digestive Diseases Centre, Translational Medical Sciences, University of Nottingham , Nottingham , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher\u00a0P","family":"Fox","sequence":"additional","affiliation":[{"name":"Centre for Cancer Studies, Translational Medical Sciences, School of Medicine, University of Nottingham , Derby , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-1028","authenticated-orcid":false,"given":"Christian 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