Manejo práctico de la intensificación del tratamiento biológico en los pacientes con enfermedad inflamatoria intestinal

Biological treatment with drugs targeting tumor necrosis factor-α (anti-TNF) has improved the therapeutic options for inflammatory bowel disease (IBD). These drugs have shown high clinical efficacy associated primarily with mucosal healing and improvement in the patient́s quality of life. However, a high percentage of patients do not respond to initial treatment or lose the achieved response over time. To prevent or attenuate anti-TNF failure, several strategies have been employed in an attitude known as treatment intensification. These strategies include: increasing anti-TNF dosage, shortening the intervals in administration, associating anti-TNF to an immunomodulator or, although not strictly an attitude of intensification, switching to another anti-TNF or biological drug (there are few alternatives in IBD). These strategies are usually applied empirically, based on the clinical condition of patients. Recently, the introduction of anti-TNF monitoring in clinical practice through the determination of drug serum levels and presence of antibodies to the drug, allows a more accurate selection of strategies. Nevertheless, there are certain aspects of the intensification of anti-TNF treatment that remain unresolved and patients with intensified treatment must be closely and thoroughly monitored because of the high risk of infection.