Van Assche Gert, Vermeire Séverine, Rutgeerts Paul
Division of Gastroenterology, University of Leuven, 49, Herestraat 3000 Leuven, Belgium.
Curr Gastroenterol Rep. 2008 Dec;10(6):591-6. doi: 10.1007/s11894-008-0107-7.
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.
尽管使用生物制剂，特别是抗肿瘤坏死因子（TNF）抗体治疗炎症性肠病已有十多年的临床经验，但最佳治疗策略仍存在争议。免疫原性导致的继发性反应丧失是治疗性抗体使用中固有的问题，并且具有重要影响。使用嵌合抗TNF抗体英夫利昔单抗时，定期维持治疗可将反应丧失的风险降至最低，并且没有明确证据表明在此情况下联合使用免疫抑制剂具有附加价值。更多人源化抗TNF抗体已进入临床实践，为炎症性肠病患者开辟了新的前景，但超过三分之一的患者仍需要调整给药方案。由于生物制剂与其他免疫疗法一样，存在感染风险以及可能引发某些恶性肿瘤的风险，因此选择合适的治疗患者并评估临床症状以外的疾病活动有助于优化我们治疗方法的风险效益比。
