a Department of Hepato-Gastroenterology , University Hospitals Leuven, Uz Gasthuisberg , Leuven , Belgium.
b Imelda GI Clinical Research Centre , Imeldaziekenhuis Bonheiden , Bonheiden , Belgium.
Expert Opin Biol Ther. 2016 Oct;16(10):1277-90. doi: 10.1080/14712598.2016.1203897. Epub 2016 Jul 4.
Crohn's disease (CD) and ulcerative colitis (UC) are chronic disabling conditions. Monoclonal antibody therapy directed against tumor necrosis factor-alpha (anti-TNF) has revolutionized the care of patients with inflammatory bowel disease (IBD).
Considerations before starting anti-TNF therapy are highlighted: the best time to start with anti-TNF therapy, either alone or in combination with an immunomodulator, the choice of an anti-TNF agent and the contra-indications to anti-TNF therapy. Primary nonresponse and secondary loss of response are discussed. De-escalating therapy, the role of therapeutic drug monitoring and the use of biosimilars, are handled. Finally, the future directions of anti-TNF therapy are emphasized.
Anti-TNF therapy remains the cornerstone in the treatment of IBD. When initiating long-term therapy, safety and cost issues are of great importance. The therapeutic armamentarium in the treatment of IBD is rapidly growing. Therefore, the challenge is to optimize the use and refine the exact position of anti-TNF therapy in the near future, with personalized medicine as the ultimate goal.
克罗恩病（CD）和溃疡性结肠炎（UC）是慢性致残性疾病。针对肿瘤坏死因子-α（抗 TNF）的单克隆抗体治疗彻底改变了炎症性肠病（IBD）患者的治疗方式。
本文强调了开始抗 TNF 治疗前需要考虑的因素：单独或联合免疫调节剂开始抗 TNF 治疗的最佳时机、抗 TNF 药物的选择以及抗 TNF 治疗的禁忌证。讨论了原发性无应答和继发性应答丧失。还介绍了治疗降级、治疗药物监测的作用以及生物仿制药的使用。最后，强调了抗 TNF 治疗的未来方向。
抗 TNF 治疗仍然是 IBD 治疗的基石。在开始长期治疗时，安全性和成本问题非常重要。IBD 治疗的治疗手段正在迅速发展。因此，未来的挑战是优化抗 TNF 治疗的使用，并在不久的将来精确确定其确切位置，以实现个体化医疗为最终目标。
