What should be done in patients with inflammatory bowel diseases those lose a response to biological therapy?

Authors: M. Lukáš
Authors‘ workplace: Klinické a výzkumné centrum pro střevní záněty, ISCARE Lighthouse a 1. LF UK, Praha Ústav klinické biochemie a laboratorní diagnostiky 1. LF UK, Praha
Published in: Gastroent Hepatol 2011; 65(1): 0
Category: IBD: Review Article


Biological therapy became an important component of conservative therapy for patients with moderate or severe inflammatory bowel disease (IBD) at the beginning of this century. Primary failure in biological therapy is relatively rare and was described in clinical practice for 10% of IBD patients. From the clinical point of view, secondary failure is more frequent and occurs in 15–20% of patients during one year of therapy. Crucial questions which should be addressed prior to the intensification or withdrawal of biological therapy include confirmation of the presence of an inflammation, IBD complications and, primarily, opportunistic infections. Intensification of biological therapy is effective in 2/3 of IBD patients, who enjoy long-term benefits following such treatment. It is significant that half of patients are subsequently able to return to their original therapeutic strategy.

Klíčová slova:
inflammatory bowel diseases – Crohn’s disease – ulcerative colitis – biological therapy – infliximab – adalimumab


1. Peyrin–Biroulet L, Deltenre P, de Suray N et al. Efficacy and Safety of Tumor Necrosis Factor Antagonists in Crohn’s Disease: Meta-Analysis of Placebo-Controlled Trials. Clin Gastroenterol Hepatol 2008; 6(6): 644–653.

2. Rutgeerts P, Sanborn WJ, Feagan BG et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005; 353: 2462–2476.

3. Gies N, Kroeker KI, Wong K et al. Treatment of ulcerative colitis with adalimumab or infliximab: long-term follow-up of a single-centre kohort. Alimentary Pharmacology Therapeutics 2010; 32(4): 522–528.

4. Bultman E, Kuipers EJ, van der Woude CJ. Systematic review: steroid withdrawal in anti-TNF-treated patients with inflammatory bowel disease. Aliment Pharmacol Ther 2010; 32(3): 313–323.

5. Colombel JF, Sandborn WJ, Reinisch W et al. Inflximab, azathioprine, or combination therapy for Crohn‘s disease. N Engl J Med 2010; 362(15): 1383–1395.

6. Lukáš M, Bortlík M. Infliximab a nebo azathioprin u nemocných s Crohnovou chorobou. Komentovaný referát ke studii SONIC. Remedia 2009; 19: 381–384.

7. Schnitzler F, Fidder H, Ferrante M et al. Long-term outcome of treatment with infliximab: results from a single-centre kohort in 614 patients with Crohn‘s disease. Gut 2009; 58(4): 492–500

Paediatric gastroenterology Gastroenterology and hepatology Surgery
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account