Hôpital Nord, service de gastro-entérologie, 42000 Saint-Étienne
Anti-TNF treatments have become one of the key therapies for inflammatory bowel diseases. However, there is a loss of clinical response to anti-TNF, primary or secondary, especially in connection with immunogenic and inflammatory causes. Optimization allows therapeutic savings, is profitable in terms of health costs, without infectious over-risks, but is not effective in all patients. Pharmacokinetics, based on residual dose and anti-TNF antibodies, is used to guide the management of these patients. The best candidates for optimizing their anti-TNF treatment, by increasing the dose or reducing the interval between injections, are those with low residual levels without antibodies. In contrast, in patients with high levels of antibodies, it will be preferable to switch on anti-TNF and/or to add immunosuppressive therapy. There are still several parameters to define more precisely in order to guide the optimization and to obtain a personalized support, in particular the objectives of the residual levels of anti-TNF for each molecule.
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