Predictors and optimal management of tumor necrosis factor antagonist nonresponse in inflammatory bowel disease:A literature review  

作　　者：Liang-Fang Wang Ping-Run Chen Si-Ke He Shi-Hao Duan Yan Zhang 

机构地区：[1]Department of Gastroenterology and Hepatology,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China [2]West China School of Medicine,Sichuan University,Chengdu 610041,Sichuan Province,China

出　　处：《World Journal of Gastroenterology》2023年第29期4481-4498,共18页世界胃肠病学杂志（英文版）

摘　　要：Tumor necrosis factor-α(TNF-α)antagonists,the first biologics approved for treating patients with inflammatory bowel disease(IBD),are effective for the induction and maintenance of remission and significantly improving prognosis.However,up to one-third of treated patients show primary nonresponse(PNR)to anti-TNF-αtherapies,and 23%-50%of IBD patients experience loss of response(LOR)to these biologics during subsequent treatment.There is still no recognized predictor for evaluating the efficacy of anti-TNF drugs.This review summarizes the existing predictors of PNR and LOR to anti-TNF in IBD patients.Most predictors remain controversial,and only previous surgical history,disease manifestations,drug concentrations,antidrug antibodies,serum albumin,some biologic markers,and some genetic markers may be potentially predictive.In addition,we also discuss the next steps of treatment for patients with PNR or LOR to TNF antagonists.Therapeutic drug monitoring plays an important role in treatment selection.Dose escalation,combination therapy,switching to a different anti-TNF drug,or switching to a biologic with a different mechanism of action can be selected based on the concentration of the drug and/or antidrug antibodies.

关 键 词：PREDICTOR Management Tumor necrosis factor antagonist Primary nonresponse Secondary nonresponse Inflammatory bowel disease 

分 类 号：R574[医药卫生—消化系统]