Anjie Suzanne I, Hulshoff Melanie S, D'Haens Geert
Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Academic Medical Centre, Amsterdam, Netherlands.
Expert Opin Biol Ther. 2023 Apr;23(4):341-351. doi: 10.1080/14712598.2023.2198086. Epub 2023 Apr 9.
During the last decades, biologics have revolutionized the treatment of Crohn's disease and ulcerative colitis. Even though the inflammatory bowel disease (IBD) armamentarium is rapidly expanding with novel biologics, anti-tumor necrosis factor (TNF) antibodies remain the first-line biologic therapy in most areas of the world. However, anti-TNF therapy is not effective in all patients (primary non-response) and patients can lose effect over time (secondary loss of response).
This review provides an overview of the current induction and maintenance dosing regimens of the available anti-TNF antibodies and associated challenges in adult patients with IBD. We outline different strategies to overcome these difficulties, including combination therapy, therapeutic drug monitoring (TDM), and dose escalation. Finally, we discuss expected future progress in anti-TNF management.
Anti-TNF agents will remain a cornerstone of IBD treatment in the coming decade. Progress will be made in biomarkers for the prediction of response and individualized dosing regimens. The advent of subcutaneous infliximab challenges the need for concomitant immunosuppression.
在过去几十年中，生物制剂彻底改变了克罗恩病和溃疡性结肠炎的治疗方式。尽管随着新型生物制剂的出现，炎症性肠病（IBD）的治疗手段迅速增加，但在世界大多数地区，抗肿瘤坏死因子（TNF）抗体仍然是一线生物治疗药物。然而，抗TNF治疗并非对所有患者都有效（原发性无反应），且患者可能会随着时间推移失去疗效（继发性反应丧失）。
本综述概述了现有抗TNF抗体在成年IBD患者中的当前诱导和维持给药方案以及相关挑战。我们概述了克服这些困难的不同策略，包括联合治疗、治疗药物监测（TDM）和剂量递增。最后，我们讨论了抗TNF治疗未来预期的进展。
在未来十年，抗TNF药物仍将是IBD治疗的基石。在预测反应的生物标志物和个体化给药方案方面将取得进展。皮下注射英夫利昔单抗的出现对联合免疫抑制的需求提出了挑战。
