Targeting TNF-α for the treatment of inflammatory bowel disease

Abstract

Introduction: The advent of tumor necrosis factor (TNF) antagonists represented a radical change in the management of inflammatory bowel disease (IBD). Both in short- and long-term, anti-TNF therapy has been shown to reduce symptoms, heal mucosal ulcers, reduce hospitalizations and surgeries and spare corticosteroids.

Areas covered: A literature search to August 2013 was performed to identify the most relevant reports on the use of TNF antagonists in IBD. First, the authors focused on the mechanism of action of TNF antagonists. Second, they evaluated different indications, contraindications, the optimal time to start and the role of combining TNF antagonists with immunomodulators. Third, they explored the importance of mucosal healing, followed by the controversial topic on when TNF antagonists should be stopped. This is followed by the subjects of treatment failure, immunogenicity and therapeutic drug monitoring. Last, they analyzed safety issues including exposure to TNF antagonists during pregnancy.

Expert opinion: TNF antagonists have become indispensable in the management of IBD. Efforts to focus on treatment of inflammatory signs only and on optimization of treatment with therapeutic drug monitoring are underway. The advent of several new compounds and “biosimilars” will further challenge the position of TNF antagonists in the treatment algorithm of IBD.

Keywords::

• adalimumab
• anti-TNF
• certolizumab pegol
• combination therapy
• Crohn's disease
• efficacy
• golimumab
• immunogenicity
• inflammatory bowel disease
• infliximab
• mucosal healing
• safety
• therapeutic drug monitoring
• TNF angatonists
• ulcerative colitis
• window of opportunity

Declaration of interest

B Thomas has no competing interests to declare. R Paul has received financial support for research from UCB Pharma, Abbvie, Janssen Biologics, Merck, and Prometheus; lecture fees from Abbvie and Merck; and consultancy fees from Amgen, Merck, UCB Pharma, Genentech, BMS, Abbvie, Janssen Biologics, Millenium, Neovacs, Actogenics, and Prometheus. G Van Assche has received financial support for research from Abbvie and Ferring; lecture fees from Janssen-Cilag, Merck and Abbvie; and consultancy from PDL BioPharma, UCB Pharma, Sanofi-Aventis, Abbvie, Ferring; Novartis, Biogen Idec, Janssen Biologics, NovoNordisk, Zealand Pharma A/S, Millenium/Takeda, Shire, Novartis, and BMS. V Severine has received financial support for research from UCB Pharma, MSD and Abbvie; lecture fees from Abbvie, Merck, Ferring, UCB Pharma, and Centocor; and consultancy fees from UCB Pharma, AstraZeneca, Ferring, Abbvie, Merck, Ferring, Shire, and Pfizer. F Marc has received financial support for research from Janssen Biologics; lecture fees from Merck, Tillotts, Ferring, and Abbvie; and consultancy with Abbvie, Merck, and Janssen Biologics.

Notes

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