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REVIEW  INFLAMMATORY BOWEL DISEASE: BEYOND THE EDGE 

Minerva Gastroenterologica e Dietologica 2019 December;65(4):291-7

DOI: 10.23736/S1121-421X.19.02617-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Anti-TNF combination therapy in inflammatory bowel disease: de novo or selective?

Fabio S. MACALUSO , Ambrogio ORLANDO

Unit of Inflammatory Bowel Disease, Department of Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy



Anti-TNFs still remain the backbone of advanced therapies in inflammatory bowel diseases, but their efficacy is not universal and tends to diminish over time. As a consequence, there is the need for optimization of these treatments, and the use of combination therapy - i.e. an anti-TNF plus an immunosuppressant - is one of the main strategies. The rationale for this approach lies in the evidence that the immunosuppressant reduces the formation of antibodies directed against the anti-TNF, thus avoiding the reduction or elimination of circulating drug levels, and in the combination of the therapeutic effect of two drugs. Nowadays, two different combination therapies should be distinguished. In the “de novo” combination therapy, the anti-TNF is used in combination with an immunosuppressant from the beginning of the treatment, in order to prevent the formation of anti-drug antibodies. In the “selective” combination therapy, the immunosuppressant is added at a later time in patients who experience a loss of response during anti-TNF monotherapy due to the development of anti-drug antibodies. The purpose of this review is to summarize the available evidence on both de novo and selective combination therapy. In addition, we will express our point of view on the choice between these two different treatment modalities.


KEY WORDS: Biological products; Immunosuppressive agents; Safety; Drug monitoring

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