title: Considerations, challenges and future of anti-TNF therapy in treating inflammatory bowel disease.
abstract: Crohn's disease (CD) and ulcerative colitis (UC) are chronic disabling conditions. Monoclonal antibody therapy directed against tumor necrosis factor-alpha (anti-TNF) has revolutionized the care of patients with inflammatory bowel disease (IBD).
  
  
  
  Considerations before starting anti-TNF therapy are highlighted: the best time to start with anti-TNF therapy, either alone or in combination with an immunomodulator, the choice of an anti-TNF agent and the contra-indications to anti-TNF therapy. Primary nonresponse and secondary loss of response are discussed. De-escalating therapy, the role of therapeutic drug monitoring and the use of biosimilars, are handled. Finally, the future directions of anti-TNF therapy are emphasized.
  
  
  
  Anti-TNF therapy remains the cornerstone in the treatment of IBD. When initiating long-term therapy, safety and cost issues are of great importance. The therapeutic armamentarium in the treatment of IBD is rapidly growing. Therefore, the challenge is to optimize the use and refine the exact position of anti-TNF therapy in the near future, with personalized medicine as the ultimate goal.
authors.affiliation: a Department of Hepato-Gastroenterology , University Hospitals Leuven, Uz Gasthuisberg , Leuven , Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Pouillon
authors.affiliation: b Imelda GI Clinical Research Centre , Imeldaziekenhuis Bonheiden , Bonheiden , Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Bossuyt
authors.affiliation: c Inserm U954 and Department of Gastroenterology , Nancy University Hospital, Université de Lorraine , Vandœuvre-lès-Nancy , France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000494:pharmacology / Q000627:therapeutic use*; D059451:Biosimilar Pharmaceuticals / Q000627:therapeutic use*; D016903:Drug Monitoring; D005544:Forecasting; D006801:Humans; D007167:Immunotherapy / Q000379:methods* / Q000639:trends; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D059451:Biosimilar Pharmaceuticals; D014409:Tumor Necrosis Factor-alpha
keywords: Adalimumab; Crohn’s disease; TNF antagonists; anti-TNF; biosimilar; certolizumab pegol; combination therapy; golimumab; inflammatory bowel disease; infliximab; personalized medicine; pharmacogenomics; tailored therapy; therapeutic drug monitoring; ulcerative colitis