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. 2019 Dec;15(12):656-665.

Etiology and Management of Lack or Loss of Response to Anti-Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease

Sean Fine  1 , Kostantinos Papamichael  1 , Adam S Cheifetz  1
Affiliations

Etiology and Management of Lack or Loss of Response to Anti-Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease

Sean Fine et al. Gastroenterol Hepatol (N Y). 2019 Dec.

Abstract

The management of patients with moderate to severe inflammatory bowel disease was transformed with the arrival of anti-tumor necrosis factor (TNF) therapy. Nevertheless, a considerable number of patients do not respond to anti-TNF induction therapy (primary nonresponse) or lose response to treatment over time after initially experiencing clinical improvement (secondary loss of response). Studies suggest that these outcomes are often due to inadequate drug concentrations. Therapeutic drug monitoring (TDM) is a practical tool that can be used to better define the etiologies of and help manage primary nonresponse or secondary loss of response. Proactive TDM, or drug titration to a target trough concentration, can improve the efficacy of anti-TNF treatment and lead to favorable clinical outcomes. However, in patients with adequate anti-TNF drug concentrations and active disease, alternate pathways of inflammation (not driven by TNFa agents) are at play, and therapies with another mechanism of action should be employed.

Keywords: Primary nonresponse; antidrug antibody; secondary loss of response; therapeutic drug monitoring.

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Conflict of interest statement

Dr Cheifetz has received consultancy fees from Janssen, AbbVie, Takeda, Pfizer, Samsung, Arena Pharmaceuticals, Bacainn Therapeutics, EMD Serono, Arsanis, Grifols, and Prometheus, and has received research support from Inform Diagnostics. Dr Fine is on the speaking bureau for AbbVie. Dr Papamichael has received a lecture fee from Mitsubishi Tanabe Pharma.

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