TNF-alpha blockers in inflammatory bowel diseases: practical consensus recommendations and a user's guide.

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State: Public
Version: Final published version
Serval ID
serval:BIB_399E02A25981
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
TNF-alpha blockers in inflammatory bowel diseases: practical consensus recommendations and a user's guide.
Journal
Swiss Medical Weekly
Author(s)
Pache I., Rogler G., Felley C.
ISSN
1424-7860
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
139
Number
19-20
Pages
278-287
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; Review
Abstract
More than seventy years after their initial characterisation, the aetiology of inflammatory bowel diseases remains elusive. A recent review evaluating the incidence trends of the last 25 years concluded that an increasing incidence has been observed almost worldwide. A north-south gradient is still found in Europe. Genetic associations are variably reproduced worldwide and indicate a strong impact of environmental factors. Tumour necrosis factor alpha (TNF-alpha) has been shown to play a critical role in the pathogenesis of inflammatory bowel disease (IBD). TNF-alpha blockers are biological agents that specifically target this key cytokine in the inflammatory process and have become a mainstay in the therapy of inflammatory bowel diseases. This paper reviews the necessary investigations before using such agents, the use of such agents in pregnancy and lactation, the role of co-immunosuppression, how to monitor efficacy and safety, dose-adaptation, and the decision as to when to switch to another TNF-alpha blocker. Finally it gives recommendations for special situations. Currently there are three TNF-alpha blockers available for clinical use in IBD in Switzerland: infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). Infliximab is a chimeric monoclonal antibody composed of a human IgG1 constant region and a murine variable region and is administered intravenously. Adalimumab is a humanised monoclonal antibody, with both human IgG1 constant and variable regions. Certolizumab pegol is a pegylated, humanised monoclonal anti-TNF fragment antigen binding fragment. Both adalimumab and certolizumab pegol are administered by subcutaneous injection. The efficacy and safety of TNF-alpha blockers in Crohn's disease has been reviewed. The authors conclude that the three above-mentioned agents are effective in luminal Crohn's disease. In fistulizing Crohn's disease, TNF-alpha blockers other than infliximab require additional investigation.
Keywords
Drug Therapy, Combination, Female, Humans, Immunologic Factors/contraindications, Immunologic Factors/therapeutic use, Immunosuppressive Agents/therapeutic use, Inflammatory Bowel Diseases/drug therapy, Inflammatory Bowel Diseases/immunology, Practice Guidelines as Topic, Pregnancy, Tumor Necrosis Factor-alpha/antagonists & inhibitors, Tumor Necrosis Factor-alpha/immunology
Pubmed
Web of science
Create date
11/09/2009 9:44
Last modification date
20/08/2019 13:29
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