[Benefit of therapeutic drug monitoring of immunosuppressants and immunomodulators in the management of autoimmune diseases]

Rev Med Interne. 2022 Jul;43(7):412-418. doi: 10.1016/j.revmed.2022.03.343. Epub 2022 May 25.
[Article in French]


The pharmacokinetics of drugs, such as immunosuppressants, justify the need of measuring their blood concentrations in order to adjust their dosage. Therapeutic Drug Monitoring (TDM) of ciclosporin, tacrolimus and mycophenolate mofetil has shown its benefit particularly in the management of renal transplantees, in order to prevent graft rejection. When prescribed in autoimmune diseases, their pharmacokinetic variability and the variability of clinical response would justify TDM in practice. TDM may be useful in systemic lupus, for hydroxychloroquine, in order to monitor patient compliance. Despite insufficient data in the literature, for mycophenolate mofetil, TDM would permit to maintain clinical remission in adults and children with lupus nephritis, as well as in mucosal pemphigoid and idiopathic nephrotic syndrome in children. Studies are still necessary to validate the thresholds and TDM conditions. For azathioprine, TPMT phenotyping is recommended before prescription. For methotrexate, tacrolimus and ciclosporin, data are still sparse on the benefit of TDM, although it may improve tolerance to tacrolimus in lupus. Finally, for infliximab, in case of loss of response in maintenance, TDM may be proposed in parallel with detection of anti-drug antibodies.

Keywords: Autoimmune diseases; Immunomodulateurs; Immunomodulators; Immunosuppressants; Immunosuppresseurs; Maladies auto-immunes; Suivi thérapeutique pharmacologique; Therapeutic drug monitoring.

MeSH terms

  • Adult
  • Autoimmune Diseases* / drug therapy
  • Child
  • Cyclosporine / pharmacokinetics
  • Cyclosporine / therapeutic use
  • Drug Monitoring
  • Humans
  • Immunosuppressive Agents* / therapeutic use
  • Mycophenolic Acid / pharmacokinetics
  • Mycophenolic Acid / therapeutic use
  • Tacrolimus / pharmacokinetics
  • Tacrolimus / therapeutic use


  • Immunosuppressive Agents
  • Cyclosporine
  • Mycophenolic Acid
  • Tacrolimus