Terapeutické monitorovanie infliximabu pri nešpecifických zápalových ochoreniach čreva

English version

Authors: Y. Jalali; A. Krajcovicova; T. Hlavatý
Authors‘ workplace: IBD Center, Subdepartment of Gastroenterology and Hepatology, 5th Department of Internal Medicine, Faculty of Medicine, Comenius University and University Hospital Bratislava, Slovak Republic
Published in: Gastroent Hepatol 2018; 72(1): 41-46
Category: IBD: Review Article
doi: https://doi.org/10.14735/amgh201841

Overview

Antagonisti tumor nekrotizujúceho faktoru α sa v súčasnosti bežne používajú v liečbe stredne ťažkej až ťažkej formy Crohnovej choroby a ulceróznej kolitídy. Približne 50 % pacientov s nešpecifickými zápalovými ochoreniami čreva, ktorí v úvode profitovali z liečby antagonistami tumor nekrotizujúceho faktoru, po čase stratí liečebný účinok. Účinnosť liečby je vysoko závislá od farmakokinetiky a farmakodynamiky. Terapeutické monitorovanie liečiva (TDM – therapeutic drug monitoring), ktoré predstavuje meranie hladiny liečiva ako aj protilátok proti liečivu (ADAb – anti-drug antibodies), je novým prístupom optimalizácie liečby a dosiahnutia najnižšieho rizika straty odpovede. V súčasnosti nie je jasné presná terapeutická hladina, ktorá by zodpovedala klinickej odpovedi. Produkcia ADAb môže viesť k poklesu hladín až neutralizácii liečiva s následnou stratou liečebného účinku. Rovnako môžu ADAb prispieť k infúznym reakciám, tromboembolickým príhodám a sérovej chorobe. Predkladaný článok skúma vývoj TDM pri liečbe IBD. Skúma hlavné tvrdenia o TDM ako aj vývoj ich používania v poslednom období, skúma terapeutické rozmedzie, stratu odpovede a opisuje súčasné trendy v klinickej praxi.

Kľúčové slová:
nešpecifické zápalové ochorenia čreva – terapeutické monitorovanie liečiva – protilátky proti liečivu – biologická terapia – terapeutické rozmedzie

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

Doručeno:
21. 12. 2017

Přijato:
30. 1. 2018

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