Optimizing Immunomodulators and Anti-TNF Agents in the Therapy of Crohn Disease

被引：10

作者：

Dassopoulos, Themistocles ^{[1
]}

Sninsky, Charles A. ^{[2
]}

机构：

[1] Washington Univ, Sch Med, Div Gastroenterol, St Louis, MO 63110 USA

[2] Digest Dis Associates, Gainesville, FL 32605 USA

来源：

GASTROENTEROLOGY CLINICS OF NORTH AMERICA | 2012年 / 41卷 / 02期

关键词：

Crohn disease; Azathioprine; 6-mercaptopurine; Infliximab; Thiopurine methyltransferase; 6 thioguanine nucleotides; INFLAMMATORY-BOWEL-DISEASE; THIOPURINE METHYLTRANSFERASE ACTIVITY; ANTITUMOR NECROSIS FACTOR; LONG-TERM DURABILITY; CERTOLIZUMAB PEGOL; CLINICAL-RESPONSE; AZATHIOPRINE THERAPY; FACTOR-ALPHA; INFLIXIMAB PHARMACOKINETICS; COMBINATION THERAPY;

D O I：

10.1016/j.gtc.2012.01.004

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Randomized trials support the use of the thiopurines and anti-TNF monoclonal antibodies in treating Crohn disease. New therapeutic approaches and laboratory assays have helped optimize the use of these agents. Thiopurine methyltransferase activity should always be determined to avoid thiopurines in individuals with absent enzyme activity. The role of metabolite-adjusted dosing when initiating thiopurines is not settled. Measuring metabolites helps guide management in patients failing therapy. Loss of response to anti-TNF therapy is mitigated by maintenance therapy and concomitant immunomodulators. When loss of response to infliximab occurs, management is guided by the serum concentrations of infliximab and antibodies to infliximab.

引用

页码：393 / +

页数：18

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