Optimizing treatment of inflammatory bowel diseases with biologic agents

Despite more than a decade of clinical experience in the treatment of inflammatory bowel disease with biologic agents, particularly anti-tumor necrosis factor (TNF) antibodies, optimal treatment strategies are still debated. Secondary loss of response due to immuno-genicity is intrinsic to the use of therapeutic antibodies and has important implications. With the chimeric anti-TNF antibody, infliximab, scheduled maintenance therapy minimizes the risk of loss of response, and there is no clear evidence that concomitant immunosuppressives have added value in this setting. More humanized anti-TNF antibodies have entered clinical practice, opening new perspectives to patients with inflammatory bowel disease, but interventions in the dosing regimen remain necessary for more than one third of patients. Because biologics, like other immune therapies, carry the risk of infections and possibly of some malignancies, selecting the right patient for therapy and assessing disease activity beyond clinical symptoms aids in optimizing the benefit-to-risk ratio of our treatment approach.