[Use of TNFalpha antibodies in treatment of inflammatory bowel disease].
BACKGROUND
TNFalpha-antibodies have been used increasingly in treatment of inflammatory bowel disease (IBD) during the last years. This article provides an overview of indications, contraindications, efficacy, and side effects of this so-called biological treatment of IBD.


METHODS
Based on the clinical experience of the authors, literature was selected through a non-systematic search in PubMed.


RESULTS
TNFalpha-antibodies have a documented initial effect in 60-70 % of patients with moderate to severe luminal and/or fistulising IBD. Approximately 30 % of patients achieve remission after a relatively short treatment period. However, the effect seems to decrease during long-term treatment. It is still unsettled whether these drugs prevent colectomy in ulcerative colitis. The treatment seems to increase the risk of serious infections and there are also some indications of an increased risk of malignancy. Combination therapy with azathioprin is common and probably increases both the effect and the risk of side effects.


CONCLUSIONS
TNFalpha-antibodies have become an important part of the treatment for moderate to severe IBD, but the effect decreases during long-term treatment and has to be evaluated in light of potential side effects. Further long-term studies are necessary.
Martinsen
Tom Christian
TC
Avdeling for fordøyelses- og leversykdommer, Medisinsk klinikk, St. Olavs hospital, Olav Kyrres gate 17, 7006 Trondheim, Norway. tom.christian.martinsen@stolav.no
Herter
Ralph
R
Dybdahl
Jan H
JH
Waldum
Helge L
HL
D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D000075202:Contraindications; D003424:Crohn Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069285:Infliximab; D000068879:Adalimumab