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Determination of the Relative Potency of an Anti-TNF Monoclonal Antibody (mAb) by Neutralizing TNF Using an In Vitro Bioanalytical Method
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Anti-tumor necrosis factor nonresponders in Crohn's disease: therapeutic strategies

E Louis1, J Belaiche, C Reenaers

  • 1Department of Gastroenterology, CHU of Liège, and GIGA Research, University of Liège, BE-4000 Liège, Belgium. edouard.louis@ulg.ac.be

Digestive Diseases (Basel, Switzerland)
|September 30, 2009
PubMed

Insights

Anti-tumor necrosis factor (TNF) therapies offer new hope for Crohn's disease, but patient selection and treatment optimization are crucial for sustained remission. Addressing non-response can improve outcomes for patients with this inflammatory bowel disease.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Anti-tumor necrosis factor (TNF) therapies have transformed Crohn's disease management.
  • High rates of primary and secondary non-response limit long-term efficacy.
  • Suboptimal patient selection and treatment strategies contribute to disappointing outcomes.

Purpose of the Study:

  • To review strategies for optimizing anti-TNF therapy in Crohn's disease.
  • To highlight the importance of patient selection and treatment adjustments.
  • To discuss management of anti-TNF non-responders.

Main Methods:

  • Literature review of pivotal trials and clinical experiences with anti-TNF agents.
  • Analysis of patient selection criteria for anti-TNF therapy.
  • Evaluation of treatment optimization techniques, including co-treatment and dose adjustments.
  • Review of salvage therapies for anti-TNF non-responders.

Main Results:

  • Optimal patient selection requires confirmation of active intestinal lesions, systemic inflammation, and exclusion of complications.
  • Treatment optimization involves immunosuppressive co-therapy and adjusting anti-TNF dosage or administration frequency.
  • Second- or third-line anti-TNF agents are effective after initial treatment failure.
  • Steroids and surgery remain rescue options, with new biologics under development.

Conclusions:

  • Careful patient selection and treatment optimization significantly improve anti-TNF efficacy in Crohn's disease.
  • Strategies exist to manage non-response, including sequential anti-TNF use and rescue therapies.
  • Ongoing research into novel biologics promises further advancements in Crohn's disease treatment.

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