Intérêt du suivi immunologique des biothérapies anti-TNF

Abstract

AbstractUtility of therapeutic drug monitoring of anti-TNF biologicsDespite a good clinical efficacy, treatments targeting the tumor necrosis factor alpha (anti-TNF) are frequently confronted with primary non-response or secondary loss of response most often due to a poor choice of the therapeutic target, a suboptimal dosing of the drug or the appearance of anti-drug antibodies (ADAbs). In order to help the clinician in managing these primary or secondary resistances, algorithms have been developed based on therapeutic drug monitoring (TDM) with measurement of the serum trough concentration and detection of anti-drug antibodies. The reactive use of these algorithms during a disease flare allows restoration of the therapeutic efficacy at a lower cost compared to an empirical optimization approach. However, the clinical benefit remains more controversial, as well as the proactive use of TDM in order to prevent relapses by maintaining the serum concentration of the biologic within a therapeutic range. Despite these limitations, TDM of anti-TNF is now proposed in several international guidelines, particularly for the management of inflammatory bowel disease.