One-Year Clinical Outcomes in an IBD Cohort Who Have Previously Had Anti-TNFa Trough and Antibody Levels Assessed

Tighe, Donal; Hall, Barry; Jeyarajah, Shivashini Kirthi; Smith, Sinead; Breslin, Niall; Ryan, Barbara; McNamara, Deirdre

doi:10.1097/mib.0000000000001093

Cited by 15 publications

(28 citation statements)

References 15 publications

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“…There is however a lack of association between once off maintenance phase immunomonitoring with outcomes. Our group have done a retrospective analysis of 82 patients on maintenance infliximab and adalimumab, and we found no association between once off, anti-TNFα trough and ADA levels, with clinical response, similar to other data[ 72 ]. In future, event triggered immunomonitoring may be the best approach to incorporate immunomonotoring.…”

Section: Application Of Immunomonitoringsupporting

confidence: 88%

Clinical impact of immunomonitoring in the treatment of inflammatory bowel disease

Tighe

McNamara

2017

WJG

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Despite improvement in outcomes, loss of response (LOR) to tumor necrosis factor-alpha (TNFα) therapies is a big concern in the management of inflammatory bowel disease. LOR is associated with flares of disease, increased hospitalisation rates, need for surgical interventions, and decline in quality of life. LOR may be multifactorial, but immunogenicity makes a significant contribution. Traditionally doses of anti-TNFα have been adjusted based on clinical response, using a standard approach. Immunomonitoring involves the measurement of anti-TNFα trough and antibody levels. It takes into account the underlying pharmacokinetics of anti-TNFα therapies. Expanding on this a treat to target approach may be used, where doses are intensified, or tailored to the individual based on the measurement of anti-TNFα trough and antibody levels. This review looks at the history, evolution, and clinical impact that immunomonitoring is having in the treatment of inflammatory bowel disease. It will focus on the role of immunomonitoring in helping to achieve long lasting deep remission and mucosal healing. It will explore the different options in terms of best measuring trough and antibody levels, explore possible advantages of immunomonitoring, and discuss its role in best optimising response, at induction, during the maintenance phase of treatment, as well as a role in withdrawing or switching therapy.

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Section: Application Of Immunomonitoringsupporting

confidence: 88%

Clinical impact of immunomonitoring in the treatment of inflammatory bowel disease

Tighe

McNamara

2017

WJG

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“…A primary failure to respond to anti‐TNF treatment affects 13–40% of patients with CD and secondary response loss occurs in 23–46% of patients. In other studies, 10–30% of patients with IBD showed no initial clinical benefits after anti‐TNF therapy and more than 50% that had an initial favorable outcome lost the effect over time . In addition, a high proportion of patients with IBD relapse after anti‐TNF treatment is stopped .…”

Section: Introductionmentioning

confidence: 95%

“…In other studies, 10-30% of patients with IBD showed no initial clinical benefits after anti-TNF therapy and more than 50% that had an initial favorable outcome lost the effect over time. 15,16 In addition, a high proportion of patients with IBD relapse after anti-TNF treatment is stopped. 17,18 The overall risk of relapse after discontinuation was found to be 44% for CD and 38% for UC.…”

Section: Limitations Of Parenteral Administration Of Anti-tnf Agentsmentioning

confidence: 99%

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

Ilan

2018

Journal of Leukocyte Biology

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Immune modulating treatments are often associated with immune suppression or an opposing anti‐inflammatory paradigm. As such, there is a risk of exposing patients to infections and malignancies. Contrarily, eliciting only mild immune modulation can be insufficient for alleviating immune‐mediated damage. Oral immunotherapy is a novel approach that uses the inherent ability of the gut immune system to generate signals that specifically suppress inflammation at affected sites, without inducing generalized immune suppression. Oral immunotherapy is being developed as a method to rebalance systemic immunity and restore balance, getting it back on track, rather than pushing the immune response too much or too little in opposing directions. Here, I review recent preclinical and clinical data examining the technique and describe its primary advantages.

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“…This has led to introducing biologically based therapies (i.e., anti-TNFα) in IBD patients. However, achieving adequate response levels still remains elusive as stand-alone anti-TNFα therapies have not proven completely useful at predicting disease progression and drug response [ 54 ]. Recently, animal models suggested that the lack of response could be related to differences in the gut microbiome before and after disease initiation.…”

Section: Epigenetics and Ibdmentioning

confidence: 99%

Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention

Aleksandrova

Romero-Mosquera²,

Hernández³

2017

Nutrients

137

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Inflammatory bowel diseases (IBD) represent a growing public health concern due to increasing incidence worldwide. The current notion on the pathogenesis of IBD is that genetically susceptible individuals develop intolerance to dysregulated gut microflora (dysbiosis) and chronic inflammation develops as a result of environmental triggers. Among the environmental factors associated with IBD, diet plays an important role in modulating the gut microbiome, influencing epigenetic changes, and, therefore, could be applied as a therapeutic tool to improve the disease course. Nevertheless, the current dietary recommendations for disease prevention and management are scarce and have weak evidence. This review summarises the current knowledge on the complex interactions between diet, microbiome and epigenetics in IBD. Whereas an overabundance of calories and some macronutrients increase gut inflammation, several micronutrients have the potential to modulate it. Immunonutrition has emerged as a new concept putting forward the importance of vitamins such as vitamins A, C, E, and D, folic acid, beta carotene and trace elements such as zinc, selenium, manganese and iron. However, when assessed in clinical trials, specific micronutrients exerted a limited benefit. Beyond nutrients, an anti-inflammatory dietary pattern as a complex intervention approach has become popular in recent years. Hence, exclusive enteral nutrition in paediatric Crohn’s disease is the only nutritional intervention currently recommended as a first-line therapy. Other nutritional interventions or specific diets including the Specific Carbohydrate Diet (SCD), the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol (FODMAP) diet and, most recently, the Mediterranean diet have shown strong anti-inflammatory properties and show promise for improving disease symptoms. More work is required to evaluate the role of individual food compounds and complex nutritional interventions with the potential to decrease inflammation as a means of prevention and management of IBD.

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One-Year Clinical Outcomes in an IBD Cohort Who Have Previously Had Anti-TNFa Trough and Antibody Levels Assessed

Abstract: LOR is still a big concern with anti-TNFa therapies. Stand-alone anti-TNFa trough and antibody levels are not useful at predicting LOR/disease progression at 1 year, but low trough levels do correlate well with elevated CRP, hypoalbuminaemia, and poor response rates.

Cited by 15 publications

References 15 publications

Clinical impact of immunomonitoring in the treatment of inflammatory bowel disease

Clinical impact of immunomonitoring in the treatment of inflammatory bowel disease

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention

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