Cozijnsen M A, Samsom J N, de Ridder L
Department of Paediatric Gastroenterology, Erasmus University Medical Centre-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
Laboratory of Paediatrics, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
Paediatr Drugs. 2018 Feb;20(1):19-28. doi: 10.1007/s40272-017-0266-9.
Antibodies directed to tumour necrosis factor-α (TNF-α) are very effective in treating paediatric Crohn's disease (CD). Over the last few years, research has provided important new insights into how to optimise this treatment's effectiveness. Research on predictors for anti-TNF treatment responsiveness has revealed potential markers, but data on their accuracy in paediatric CD patients are lagging behind. Also, new evidence has become available on the safety profile of anti-TNF antibodies that suggests the assumed increased malignancy risk seen in patients on anti-TNF and thiopurine combination treatment may be linked more to thiopurine use and not to anti-TNF treatment. In addition, the early results of CT-P13, an infliximab biosimilar, in CD patients confirm the expected similarity with its originator. Thus, the effectiveness of anti-TNF antibody treatment is slowly improving, its malignancy risk is lower than assumed, and its costs are reduced by the introduction of equally effective biosimilars. Together, these trends allow for a more prominent role for anti-TNF antibodies in future treatment of paediatric CD.
针对肿瘤坏死因子-α（TNF-α）的抗体在治疗儿童克罗恩病（CD）方面非常有效。在过去几年中，研究为如何优化这种治疗的有效性提供了重要的新见解。对抗TNF治疗反应性预测指标的研究已揭示了潜在标志物，但关于其在儿童CD患者中的准确性的数据仍滞后。此外，关于抗TNF抗体安全性的新证据表明，接受抗TNF与硫唑嘌呤联合治疗的患者中假定增加的恶性肿瘤风险可能更多与硫唑嘌呤的使用有关，而非抗TNF治疗。此外，英夫利昔单抗生物类似药CT-P13在CD患者中的早期结果证实了其与原研药预期的相似性。因此，抗TNF抗体治疗的有效性正在缓慢提高，其恶性肿瘤风险低于预期，并且通过引入同样有效的生物类似药降低了成本。总体而言，这些趋势使抗TNF抗体在未来儿童CD治疗中能发挥更突出的作用。
