Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Aliment Pharmacol Ther. 2012 May;35(9):971-86. doi: 10.1111/j.1365-2036.2012.05057.x. Epub 2012 Mar 22.
The associations between clinical efficacy and infusion reactions with anti-TNF-α drug levels and the presence of antibodies against the drug have been described. However, the clinical utility of these tests in routine clinical practice remains unclear.
To examine the clinical significance of the development of antibodies against anti-TNF-α drugs and the relationship between the efficacy of these drugs and their serum levels. We also studied the clinical utility of testing for anti-TNF-α antibodies and measuring drug serum levels to optimise treatment of patients with inflammatory bowel disease (IBD) receiving these agents.
A systematic review was undertaken based on electronic searches of the PubMed database from the earliest record to February 2012. The reference lists of all relevant articles and abstracts from meetings were also consulted.
We observed a close relationship between trough levels of anti-TNF-α drug and maintenance of response to these drugs. The role of antibodies in loss of response seems to be limited to their effect favouring the clearance of the drug. The risk of infusion reactions, but not of delayed hypersensitivity reactions, is higher in patients with antibodies against the anti-TNF-α drug. Testing anti-TNF-α drug and antibody levels, together with clinical and endoscopic or radiological assessment, seems useful when attempting to optimise therapy and prevent inappropriate management of IBD patients.
Measurement of serum anti-TNF-α trough levels and antibody titres could prove useful in therapeutic drug monitoring in IBD patients treated with anti-TNF-α agents.
已有研究描述了抗 TNF-α 药物水平与输注反应之间的临床疗效以及针对该药物的抗体之间的关联。然而，这些检测在常规临床实践中的临床应用尚不清楚。
研究针对抗 TNF-α 药物的抗体的产生与这些药物的疗效之间的关系，并探讨检测抗 TNF-α 抗体和测定药物血清水平对优化接受这些药物治疗的炎症性肠病（IBD）患者的治疗的临床应用。
基于从最早记录到 2012 年 2 月的 PubMed 数据库的电子检索，进行了系统综述。还查阅了所有相关文章的参考文献列表和会议摘要。
我们观察到抗 TNF-α 药物的谷浓度与这些药物的维持反应之间存在密切关系。抗体在丧失反应中的作用似乎仅限于其促进药物清除的作用。与迟发性超敏反应相比，针对抗 TNF-α 药物的抗体的存在与输注反应的风险升高有关。当试图优化治疗并防止不适当的 IBD 患者管理时，联合检测抗 TNF-α 药物和抗体水平以及临床和内镜或影像学评估似乎有用。
在接受抗 TNF-α 药物治疗的 IBD 患者中，测定血清抗 TNF-α 谷浓度和抗体滴度可能有助于治疗药物监测。
