title: Anti-tumor necrosis factor-α monotherapy versus combination therapy with an immunomodulator in IBD.
abstract: Inflammatory bowel disease (IBD) treatment has progressed significantly over the past decade with the advent of biologics. Anti-tumor necrosis factor (anti-TNF) agents are the most widely available biologics, but the optimal approach when using them remains unclear. In this review, we highlight the currently available evidence regarding the use of anti-TNF monotherapy versus combination therapy with an immunomodulator. We focus on those patients at greatest risk for adverse events and outline the clinical approach when considering the use of combination therapy. We review the available tools through which providers may efficiently communicate these data to patients in the clinical setting.
authors.affiliation: Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
authors.forename: Parambir S
authors.initials: PS
authors.lastname: Dulai
authors.affiliation: Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
authors.forename: Corey A
authors.initials: CA
authors.lastname: Siegel
authors.affiliation: Inserm U954, Department of Hepato-Gastroenterology, Université de Lorraine, Allée du Morvan, Vandoeuvre-lès-Nancy 54511, France. Electronic address: peyrinbiroulet@gmail.com.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006801:Humans; D056747:Immunomodulation; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab; D008727:Methotrexate / Q000627:therapeutic use; D010358:Patient Participation; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D001379:Azathioprine; D008727:Methotrexate
keywords: Anti-TNF; Combination therapy; Immunomodulator; Monotherapy