Tumour necrosis factor inhibitors in inflammatory bowel disease: the story continues

Abstract

In the 1990s, tumour necrosis factor-α inhibitor therapy ushered in the biologic therapy era for inflammatory bowel disease, leading to marked improvements in treatment options and patient outcomes. There are currently four tumour necrosis factor-α inhibitors approved as treatments for ulcerative colitis and/or Crohn’s disease: infliximab, adalimumab, golimumab and certolizumab pegol. Despite the clear benefits of tumour necrosis factor-α inhibitors, a subset of patients with inflammatory bowel disease either do not respond, experience a loss of response after initial clinical improvement or report intolerance to anti-tumour necrosis factor-α therapy. Optimizing outcomes of these agents may be achieved through earlier intervention, the use of therapeutic drug monitoring and thoughtful switching within class. To complement these approaches, evolving predictive biomarkers may help inform and optimize clinical decision making by identifying patients who might potentially benefit from an alternative treatment strategy. This review will focus on the current use of tumour necrosis factor-α inhibitors in inflammatory bowel disease and the application of personalized medicine to improve future outcomes for all patients.

Caspase‐8 in endothelial cells maintains gut homeostasis and prevents small bowel inflammation in mice

“…As TNF‐α is an important necroptosis inducing cytokine, TNF‐α was elevated in the intestine of Casp8 ECko mice (see Fig 2A ), and as anti‐TNF‐α treatment is used in IBD patients (Peyrin‐Biroulet et al , 2021 ), we questioned whether the observed phenotype in Casp8 ECko could be due to TNF‐α signaling. For this, we treated Casp8 ECko mice with the TNF‐α inhibitor Enbrel ® three times per week (Fig 6G ).…”

Hypertension as a rare adverse effect caused by infliximab in the treatment of Crohn’s disease: a case report

“…Antitumor necrosis factor drugs were the first biologic agents approved for the treatment of CD. Infliximab is a monoclonal antibody against TNF, which has completely changed the treatment of CD (2). It is effective in improving clinical symptoms and promoting endoscopic healing, but it also has some side-effects, including allergic reaction, increased risk of infection, tumors (e.g., lymphoma), and autoimmune diseases (e.g., psoriasis and systemic lupus erythematosus).…”

Immunomodulator comedication promotes the reversal of anti-drug antibody-mediated loss of response to anti-TNF therapy in inflammatory bowel disease

“…It is expected that by 2030, approximately 1% of the population in industrialized countries will be affected by IBD, which will significantly affect the patient’s quality of life and increase the burden on healthcare systems [ 1 ]. With the development of monoclonal antibodies against tumor necrosis factor (TNF)-α, the management of moderate-to-severe IBD was revolutionized about two decades ago [ 2 ]. Anti-TNF therapy prolongs steroid-free clinical remission, promotes mucosal healing, facilitates closure of fistulas in CD [ 3 ], prevents complications, and improves the patient’s quality of life [ 2 ].…”

“…With the development of monoclonal antibodies against tumor necrosis factor (TNF)-α, the management of moderate-to-severe IBD was revolutionized about two decades ago [ 2 ]. Anti-TNF therapy prolongs steroid-free clinical remission, promotes mucosal healing, facilitates closure of fistulas in CD [ 3 ], prevents complications, and improves the patient’s quality of life [ 2 ]. Despite the development of newer biologics with different modes of action, the two anti-TNF agents infliximab (IFX) and adalimumab (ADL) remain first-line biological therapeutics for CD [ 4 ] and UC [ 5 ].…”

“…It is expected that by 2030, approximately 1% of the population in industrialized countries will be affected by IBD, which will significantly affect the patient's quality of life and increase the burden on healthcare systems [1]. With the development of monoclonal antibodies against tumor necrosis factor (TNF)-α, the management of moderate-tosevere IBD was revolutionized about two decades ago [2].…”