University of Chicago Medical Center, Chicago, IL 60637, USA.
Curr Med Res Opin. 2011 Sep;27(9):1803-13. doi: 10.1185/03007995.2011.604672. Epub 2011 Aug 2.
Anti-tumor necrosis factor (anti-TNF) agents are important therapies for treating Crohn's disease (CD) because they may induce and maintain remission, reduce the need for corticosteroids, decrease hospitalizations and surgeries, and heal the mucosa. Here we provide a practical, evidence-based guide to help clinicians optimize the use of adalimumab in patients with CD.
A literature search in the MEDLINE, EMBASE, and BIOSIS databases was performed for articles published between 1996 and 2010 describing adalimumab use in CD. Abstracts presented at the ACG, DDW, UEGW, ECCO, and SGNA congresses, references from review articles and published randomized clinical trials, and the manufacturer's prescribing information also were reviewed.
When selecting an anti-TNF agent, factors such as efficacy, safety, immunogenicity, patient preference, and the timing and sequencing of therapies should be considered. Important considerations for patient management include dosage selection, use of combination therapy, timing of monitoring treatment response, and evaluation of recurrent CD symptoms in a previously responding patient. We recommend that patients initiating adalimumab receive a loading dose of 160/80 mg subcutaneously at Week 0/Week 2, followed by up to 8 weeks of 40 mg every-other-week maintenance therapy prior to determining if there is non-response. During therapy, recurrent or new symptoms should be fully evaluated to ensure that they are indeed related to underlying inflammation versus other causes (e.g., intercurrent infection, bile acid diarrhea, or irritable bowel). Patients experiencing attenuation of response or inflammatory-mediated symptoms during maintenance therapy may benefit from dosage intensification to weekly adalimumab.
Considerations for the use of anti-TNF agents in CD, with an emphasis on adalimumab, are reviewed and practical patient management recommendations are presented.
抗肿瘤坏死因子（anti-TNF）药物是治疗克罗恩病（CD）的重要疗法，因为它们可以诱导和维持缓解，减少皮质类固醇的需求，降低住院和手术的次数，并促进粘膜愈合。在此，我们提供了一个实用的、基于证据的指南，以帮助临床医生优化阿达木单抗在 CD 患者中的使用。
对 1996 年至 2010 年期间发表的描述阿达木单抗在 CD 中应用的 MEDLINE、EMBASE 和 BIOSIS 数据库中的文献进行了检索。还对在 ACG、DDW、UEGW、ECCO 和 SGNA 大会上提交的摘要、综述文章和已发表的随机临床试验的参考文献以及制造商的处方信息进行了回顾。
在选择抗 TNF 药物时，应考虑疗效、安全性、免疫原性、患者偏好以及治疗的时机和顺序等因素。患者管理的重要考虑因素包括剂量选择、联合治疗的使用、监测治疗反应的时间以及评估以前有反应的患者中 CD 症状的复发。我们建议开始接受阿达木单抗治疗的患者在第 0 周/第 2 周时皮下给予 160/80mg 的负荷剂量，然后在确定是否无应答之前，最多进行 8 周的每两周 40mg 维持治疗。在治疗过程中，应充分评估复发或新出现的症状，以确保其确实与潜在炎症有关，而不是其他原因（例如，并发感染、胆汁酸腹泻或肠易激综合征）。在维持治疗期间出现应答减弱或炎症介导的症状的患者，可能受益于将剂量增加至每周阿达木单抗。
本文回顾了 CD 中使用抗 TNF 药物的注意事项，重点介绍了阿达木单抗，并提出了实用的患者管理建议。
