Prediction of response, dose intensification and loss of response to Anti TNF therapy in inflammatory bowel diseases

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Inflammatory bowel diseases (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) are life-long disabling diseases. In the last two decades, with the development of biological (anti-TNFa) therapy, the treatment paradigms for CD and UC have evolved, with a continuously increasing role of anti-TNFs. However, some patients, do not experience a beneficial effect while others need dose intensification or experience loss of response (LOR) to treatment, and management of such patients is often empirical. Much emphasis has been placed in recent years on the determination of important predictive factors. In this chapter, the authors aim to summarize the available data regarding the relationship between the evolution of clinical, laboratory parameters, serum anti-TNF concentrations/antibodies against anti-TNF agents, and clinical efficacy, as well as the need for dose intensification and management of LOR. Among the clinical and laboratory parameters early disease detection, inflammatory behaviour, early clinical efficacy and normalization of C-reactive protein, parallel immunosuppressive therapy, complete mucosal healing and smoking may predict clinical efficacy and need for surgery. In addition, monitoring drug levels and antibodies may play an emerging role in the management of LOR (i.e. to confirm adherence, allow for dose intensification, or provide rationale for switching to another anti-TNF agent or to a different class of biological agent) in the coming years. The optimal method of detection has not yet been totally defined. In clinical practice, meticulous complex assessment of clinical symptoms, confirmation of active disease by endoscopic or radiological imaging, and excluding complications remain necessary. By highlighting some of the important clinical, laboratory and pharmacological markers, it is our aim to assist clinicians in the everyday practical decision-making when choosing the treatment strategy for patients suffering from inflammatory bowel diseases.

Original languageEnglish
Title of host publicationCrohn's Disease
Subtitle of host publicationClassification, Diagnosis and Treatment Options
PublisherNova Science Publishers, Inc.
Pages271-286
Number of pages16
ISBN (Print)9781626185838
Publication statusPublished - Dec 1 2013

Keywords

  • Anti-TNF
  • Crohn's disease
  • Dose intensification
  • Efficacy
  • Loss of response
  • Prediction
  • Ulcerative colitis

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Miheller, P., & Lakatos, P. L. (2013). Prediction of response, dose intensification and loss of response to Anti TNF therapy in inflammatory bowel diseases. In Crohn's Disease: Classification, Diagnosis and Treatment Options (pp. 271-286). Nova Science Publishers, Inc..