Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, F-31300, France.
Département de Gastroentérologie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.
Curr Opin Pharmacol. 2020 Oct;54:51-58. doi: 10.1016/j.coph.2020.07.012. Epub 2020 Sep 15.
Moderate to severe inflammatory bowel disease patients can fail to respond to conventional therapy and/or to biologic treatment. In the era of TNFα antagonists and other non-anti-TNF biologic drugs, it is important to review the literature on biologic treatment failure, which could be defined as primary non-response, secondary loss of response and intolerance. Therapeutic drug monitoring (TDM), that is, drug trough level and antidrug antibodies, should enable to determine the mechanisms of treatment failure and to optimize drug efficacy. There is a consensus on reactive TDM at the time of loss of response. Proactive TDM could be of interest during induction and/or maintenance, but randomized controlled trials are required.
中重度炎症性肠病患者可能对常规治疗和/或生物治疗无应答。在 TNFα 拮抗剂和其他非抗 TNF 生物药物时代，回顾生物治疗失败的文献很重要，生物治疗失败可定义为原发性无应答、继发性应答丧失和不耐受。治疗药物监测（therapeutic drug monitoring，TDM），即药物谷浓度和抗药物抗体，有助于确定治疗失败的机制并优化药物疗效。在应答丧失时进行反应性 TDM 已达成共识。在诱导期和/或维持期进行前瞻性 TDM 可能会有意义，但需要进行随机对照试验。
