Approach to loss of response to advanced therapies in inflammatory bowel disease  

作　　者：Nikil Vootukuru Abhinav Vasudevan 

机构地区：[1]Department of Gastroenterology and Hepatology,Eastern Health,Victoria,Box Hill 3128,Australia [2]Eastern Health Clinical School,Monash University,Victoria,Box Hill 3128,Australia

出　　处：《World Journal of Gastroenterology》2024年第22期2902-2919,共18页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Remarkable progress over the last decade has equipped clinicians with many options in the treatment of inflammatory bowel disease.Clinicians now have the unique opportunity to provide individualized treatment that can achieve and sustain remission in many patients.However,issues of primary non-response(PNR)and secondary loss of response(SLOR)to non-tumour necrosis factor inhibitor(TNFi)therapies remains a common problem.Specific issues include the choice of optimization of therapy,identifying when dose optimization will recapture response,establishing optimal dose for escalation and when to switch therapy.AIM To explores the issues of PNR and SLOR to non-TNFi therapies.METHODS This review explores the current evidence and literature to elucidate management options in cases of PNR/SLOR.It will also explore potential predictors for response following SLOR/PNR to therapies including the role of therapeutic drug monitoring(TDM).RESULTS In the setting of PNR and loss of response to alpha-beta7-integrin inhibitors and interleukin(IL)-12 and IL-23 inhibitors dose optimization is a reasonable option to capture response.For Janus kinase inhibitors dose optimization can be utilized to recapture response with loss of response.CONCLUSION The role of TDM in the setting of advanced non-TNFi therapies to identify patients who require dose optimization and as a predictor for clinical remission is not yet established and this remains an area that should be addressed in the future.

关 键 词：Inflammatory bowel disease Ulcerative colitis CROHN BIOLOGICS Interleukin-12 and interleukin-23 inhibitors Alpha-beta7-integrin inhibitors Janus kinase inhibitors Sphingosine-1-phosphate receptor modulators 

分 类 号：R574[医药卫生—消化系统]