Anti-TNF-alpha treatment strategies: results and clinical perspectives

The advent of anti-TNF therapies has led to a significant expansion of the therapeutic armamentarium for inflammatory bowel diseases. Control of inflammation has been achieved with three biologic agents infliximab, adalimumab and certolizumab pegol. All agents are effective in both induction and maintenance of remission. For fistula heating in Crohn's disease, both infliximab and adalimumab have been shown to be effective, whereas for mucosal heating hard evidence is only available for infliximab. Anti-TNF agents appear to be more effective in patients who have a shorter disease history and who have not yet been treated with any of these agents. There is a clear tendency to use anti TNF therapy earlier in the course of inflammatory bowel disease, but predictive markers to select patients who realty need these therapies are urgently needed. (C) 2009 Elsevier Masson SAS. All rights reserved.