Personalized treatment with anti-TNF agents in inflammatory bowel disease

Treatment with anti-TNF agents has contributed to a better disease control with a reduction in (late) complications of inflammatory bowel disease (IBD). Unfortunately, approximately 35% of patients fail to respond to anti-TNF induction therapy and these patients are labeled as primary non-responders. Up to 50% of patients who initially respond to anti-TNF therapy lose response over time (i.e. secondary loss of response), which often prompts discontinuation of treatment. An important factor which contributes to secondary loss of response is inadequate drug exposure and the formation of anti-drug antibodies (ADA). Although novel therapeutic agents may offer treatment alternatives for some IBD patients, anti-TNF agents are up till now still the most powerful drugs available for inducing mucosal healing. Therefore, optimizing anti-TNF treatment in order to improve treatment efficacy is crucial. Personalized dosing by taking factors influencing the pharmacokinetics of the drug into account was investigated in part one of this thesis. Part two demonstrates the pharmacokinetics, efficacy and safety of biosimilar infliximab CT-P13 in the treatment of IBD.