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Anti-TNF combination therapy in inflammatory bowel disease: de novo or selective?

Fabio S Macaluso1, Ambrogio Orlando2

  • 1Unit of Inflammatory Bowel Disease, Department of Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy - fsmacaluso@gmail.com.

Minerva Gastroenterologica E Dietologica
|October 12, 2019
PubMed

Insights

Combination therapy with anti-tumor necrosis factor (anti-TNF) agents and immunosuppressants optimizes inflammatory bowel disease treatment. This review examines "de novo" and "selective" combination strategies to improve long-term efficacy.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Anti-tumor necrosis factor (anti-TNF) therapies are foundational for inflammatory bowel diseases (IBD).
  • Treatment efficacy can be limited by universal non-response and diminishing effectiveness over time.
  • Combination therapy with immunosuppressants is a key strategy to enhance anti-TNF treatment outcomes.

Purpose of the Study:

  • To review current evidence on "de novo" and "selective" anti-TNF combination therapies in IBD.
  • To compare the efficacy and rationale of these two distinct combination approaches.
  • To provide expert opinion on selecting between de novo and selective combination strategies.

Main Methods:

  • Literature review of studies investigating anti-TNF and immunosuppressant combination therapies.
  • Analysis of data on anti-drug antibody formation and clinical response.
  • Comparative assessment of "de novo" versus "selective" combination therapy strategies.

Main Results:

  • Immunosuppressants mitigate anti-drug antibody formation, preserving anti-TNF drug levels and efficacy.
  • "De novo" combination therapy aims to prevent antibody development from treatment initiation.
  • "Selective" combination therapy introduces immunosuppressants upon loss of response due to antibodies.

Conclusions:

  • Combination therapy is crucial for optimizing anti-TNF treatment in IBD.
  • Both "de novo" and "selective" approaches offer distinct advantages in managing IBD.
  • Strategic selection between these combination therapies is vital for sustained patient response.

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