Considerations, challenges and future of anti-TNF therapy in treating inflammatory bowel disease

ABSTRACT

Introduction: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic disabling conditions. Monoclonal antibody therapy directed against tumor necrosis factor-alpha (anti-TNF) has revolutionized the care of patients with inflammatory bowel disease (IBD).

Areas covered: Considerations before starting anti-TNF therapy are highlighted: the best time to start with anti-TNF therapy, either alone or in combination with an immunomodulator, the choice of an anti-TNF agent and the contra-indications to anti-TNF therapy. Primary nonresponse and secondary loss of response are discussed. De-escalating therapy, the role of therapeutic drug monitoring and the use of biosimilars, are handled. Finally, the future directions of anti-TNF therapy are emphasized.

Expert opinion: Anti-TNF therapy remains the cornerstone in the treatment of IBD. When initiating long-term therapy, safety and cost issues are of great importance. The therapeutic armamentarium in the treatment of IBD is rapidly growing. Therefore, the challenge is to optimize the use and refine the exact position of anti-TNF therapy in the near future, with personalized medicine as the ultimate goal.

KEYWORDS:

• Adalimumab
• anti-TNF
• biosimilar
• combination therapy
• certolizumab pegol
• Crohn’s disease
• golimumab
• inflammatory bowel disease
• infliximab
• personalized medicine
• pharmacogenomics
• tailored therapy
• therapeutic drug monitoring
• TNF antagonists
• ulcerative colitis

Article highlights

• Considerations before starting anti-TNF therapy: optimal time to start anti-TNF, in monotherapy or in combination with an immunomodulator, the choice of an anti-TNF agent and contraindications to anti-TNF therapy.

• Dealing with anti-TNF failure.

• The role of therapeutic drug monitoring.

• Efficacy profile and safety of biosimilars.

• Optimizing administration of anti-TNF and tailoring therapy on an individual patient to improve outcome and to reduce the potential risks of anti-TNF therapy.

This box summarizes key points contained in the article.

Declaration of interest

P Bossuyt is part of the advisory board for Mundipharma, Dr Falk Benelux, Merck Sharp & Dohme and Hospira; he has received lecture fees from AbbVie, Takeda and Vifor Pharma and he has received an educational grant from AbbVie. L Peyrin-Biroulet received consulting fees from Merck, AbbVie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor Pharma, Therakos, Pharmacosmos, Pilège, Bristol-Myers Squibb, UCB Pharma, Hospira, Celltrion, Biogaran, Boerhinger-Ingelheim, Lilly, Pfizer, HAC-Pharma, Index Pharmaceuticals, Amgen, Sandoz, Forward Pharma GmbH and Celgene. He has received lecture fees from Merck, AbbVie, Takeda, Janssen, Ferring, Norgine, Tillots, Vifor Pharma, Therakos, Mitsubishi and HAC-Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.