CRITICAL ANALYSIS OF ANTI-TNF USE IN THE ERA OF NEW BIOLOGICAL AGENTS IN INFLAMMATORY BOWEL DISEASE

Análise crítica do uso dos anti-TNF na era dos novos agentes biológicos na doença inflamatória intestinal

ABSTRACT

BACKGROUND:

Inflammatory bowel diseases (IBD), both Crohn’s disease and ulcerative colitis, are chronic immune-mediated diseases that present a relapsing and remitting course and requires long-term treatment. Anti-tumor necrosis factor (anti-TNF) therapy has changed the management of the disease by reducing the need for hospitalizations, surgeries and improving patient´s quality of life.

OBJECTIVE:

The aim of this review is to discuss the role of anti-TNF agents in IBD, highlighting the situations where its use as first-line therapy would be appropriate.

METHODS:

Narrative review summarizing the best available evidence on the topic based on searches in databases such as MedLine and PubMed up to April 2020 using the following keywords: “inflammatory bowel disease’’, “anti-TNF agents” and ‘’biologic therapy’’.

CONCLUSION:

Biological therapy remains the cornerstone in the treatment of IBD. In the absence of head-to-head comparisons, the choice of the biological agent may be challenging and should take into account several variables. Anti-TNF agents should be considered as first line therapy in specific scenarios such as acute severe ulcerative colitis, fistulizing Crohn’s disease and extra-intestinal manifestations of IBD, given the strong body of evidence supporting its efficacy and safety in these situations.

HEADINGS:
Inflammatory bowel diseases; Tumor necrosis factor-alpha, antagonists & inhibitors; Biologic therapy; Crohn disease, drug therapy; Ulcerative colitis, drug therapy