Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2017; 8(3): 155-161
Published online Aug 6, 2017. doi: 10.4292/wjgpt.v8.i3.155
Strategies for overcoming anti-tumor necrosis factor drug antibodies in inflammatory bowel disease: Case series and review of literature
Mansi M Kothari, Douglas L Nguyen, Nimisha K Parekh
Mansi M Kothari, Douglas L Nguyen, Nimisha K Parekh, Department of Medicine (Gastroenterology), University of California-Irvine, Irvine, CA 92868, United States
Author contributions: Nguyen DL and Parekh NK designed the research; Kothari MM performed the research, gathered data, and analyzed the data; Kothari MM, Nguyen DL and Parekh NK wrote the paper.
Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mansi M Kothari, MD, Fellow, Department of Medicine (Gastroenterology), University of California-Irvine, UC Irvine Medical Center, 101 The City Drive S, Orange, Irvine, CA 92868, United States. mmkothar@uci.edu
Telephone: +1-714-4566745
Received: February 8, 2017
Peer-review started: February 9, 2017
First decision: March 13, 2017
Revised: May 14, 2017
Accepted: June 6, 2017
Article in press: June 7, 2017
Published online: August 6, 2017
Processing time: 173 Days and 10.4 Hours
Core Tip

Core tip: One of the main challenges of anti-tumor necrosis factor use in inflammatory bowel disease is immunogenicity, or the immune-mediated formation of drug antibodies. Therapeutic drug monitoring allows for measurement of serum drug levels and antidrug antibodies. Previously it was thought that antibody formation was indication to switch to an alternate agent; however, more recent literature, which we review in this article, suggests that a low level of antidrug antibodies can be overcome by dose escalation of the biologic drug and/or addition of an immunomodulator. We describe a small case series of patients in whom this strategy was used, in conjunction with therapeutic drug monitoring, with some success.