title: Targeting TNF-α for the treatment of inflammatory bowel disease.
abstract: BACKGROUND
  The advent of tumor necrosis factor (TNF) antagonists represented a radical change in the management of inflammatory bowel disease (IBD). Both in short- and long-term, anti-TNF therapy has been shown to reduce symptoms, heal mucosal ulcers, reduce hospitalizations and surgeries and spare corticosteroids.
  
  
  METHODS
  A literature search to August 2013 was performed to identify the most relevant reports on the use of TNF antagonists in IBD. First, the authors focused on the mechanism of action of TNF antagonists. Second, they evaluated different indications, contraindications, the optimal time to start and the role of combining TNF antagonists with immunomodulators. Third, they explored the importance of mucosal healing, followed by the controversial topic on when TNF antagonists should be stopped. This is followed by the subjects of treatment failure, immunogenicity and therapeutic drug monitoring. Last, they analyzed safety issues including exposure to TNF antagonists during pregnancy.
  
  
  CONCLUSIONS
  TNF antagonists have become indispensable in the management of IBD. Efforts to focus on treatment of inflammatory signs only and on optimization of treatment with therapeutic drug monitoring are underway. The advent of several new compounds and "biosimilars" will further challenge the position of TNF antagonists in the treatment algorithm of IBD.
authors.affiliation: University of Leuven, University Hospitals Gasthuisberg, KU Leuven, Department of Gastroenterology , Herestraat 49, O&N1, Box 701, 3000 Leuven , Belgium +3216330277 ; +3216330723 ; thomas.billiet@med.kuleuven.be.
authors.forename: Thomas
authors.initials: T
authors.lastname: Billiet
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
authors.forename: Marc
authors.initials: M
authors.lastname: Ferrante
authors.forename: Gert
authors.initials: G
authors.lastname: Van Assche
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D008297:Male; D058990:Molecular Targeted Therapy; D018579:Patient Selection; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha