Timing of proper introduction, optimization and maintenance of anti-TNF therapy in IBD: Results from a Delphi consensus

Dig Liver Dis. 2024 Jan;56(1):98-105. doi: 10.1016/j.dld.2023.09.003. Epub 2023 Sep 21.

Abstract

Background: Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBDs) with a rapidly growing worldwide incidence. The last decades presented rapid progress in pharmacological treatment leading in many cases to clinical and endoscopic remission, including biological treatment with anti-TNF agents.

Aim: The exact timing of introduction, optimization and maintenance of anti-TNF therapy in IBDs is not thoroughly covered in current guidelines.

Methods: We used the Delphi panel methodology to gather the IBD experts' views and achieve consensus for clinical recommendations on introducing and maintaining anti-TNF therapy for patients with IBDs.

Results: Twelve recommendations achieved a high level of consensus in two assessment rounds by 52 (1st round) and 47 (2nd round) IBD experts.

Conclusion: In many clinical situations, the early use of anti-TNF therapy is recommended. Nowadays, the cost-efficacy profile of anti-TNF biosimilars makes them the first-line drug in a substantial proportion of patients, thus providing the opportunity to increase access to biological therapy.

Keywords: Anti-TNF; Crohn's disease; Delphi panel; Inflammatory bowel disease; Ulcerative colitis.

MeSH terms

  • Biosimilar Pharmaceuticals* / therapeutic use
  • Colitis, Ulcerative* / drug therapy
  • Consensus
  • Delphi Technique
  • Humans
  • Inflammatory Bowel Diseases* / drug therapy
  • Infliximab / therapeutic use
  • Tumor Necrosis Factor Inhibitors / therapeutic use
  • Tumor Necrosis Factor-alpha / therapeutic use

Substances

  • Infliximab
  • Tumor Necrosis Factor Inhibitors
  • Biosimilar Pharmaceuticals
  • Tumor Necrosis Factor-alpha