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Optimizing biological therapy in Crohn's disease

Krisztina Barbara Gecse1, Zsuzsanna Végh1, Péter László Lakatos

  • 1a First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.

Expert Review of Gastroenterology & Hepatology
|October 17, 2015
PubMed

Insights

Anti-tumor necrosis factor (TNF) therapies are vital for inflammatory bowel diseases. This review explores why some patients lose response to anti-TNF drugs and how to optimize treatment using therapeutic drug monitoring.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Anti-tumor necrosis factor (TNF) therapy has transformed inflammatory bowel disease (IBD) management.
  • A substantial number of patients exhibit primary non-response or secondary loss of response to anti-TNF agents.
  • Therapeutic drug monitoring (TDM) is increasingly utilized to understand and manage loss of response.

Purpose of the Study:

  • To review predictors of efficacy and outcomes for anti-TNF therapy in IBD.
  • To elucidate the mechanisms underlying anti-TNF/biological failure in Crohn's disease.
  • To identify strategies for optimizing biological treatment in IBD patients.

Main Methods:

  • Literature review of studies on anti-TNF therapy in inflammatory bowel diseases.
  • Analysis of data on predictors of response and non-response.
  • Examination of mechanisms of therapeutic failure.
  • Synthesis of strategies for treatment optimization.

Main Results:

  • Predictors of anti-TNF efficacy and outcomes vary.
  • Multiple mechanisms contribute to anti-TNF/biological failure.
  • Therapeutic drug monitoring aids in identifying causes of non-response.

Conclusions:

  • Optimizing anti-TNF therapy requires understanding individual patient responses.
  • Identifying mechanisms of failure through TDM can guide treatment adjustments.
  • Personalized strategies are crucial for improving outcomes in IBD patients treated with biologics.
Keywords:
Crohn’s diseaseadalimumabinfliximabtherapeutic drug level monitoringulcerative colitis

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