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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2018; 72(1): 41–46. doi:10.14735/amgh201841.

Terapeutické monitorovanie infliximabu pri nešpecifických zápalových ochoreniach čreva

Yashar Jalali, Anna Krajčovičová, Tibor Hlavatý

Souhrn

Antagonisti tumor nekrotizujúceho faktoru α sa v súčasnosti bežne používajú v liečbe stredne ťažkej až ťažkej formy Crohnovej choroby a ulceróznej kolitídy. Približne 50 % pacientov s nešpecifickými zápalovými ochoreniami čreva, ktorí v úvode profitovali z liečby antagonistami tumor nekrotizujúceho faktoru, po čase stratí liečebný účinok. Účinnosť liečby je vysoko závislá od farmakokinetiky a farmakodynamiky. Terapeutické monitorovanie liečiva (TDM – therapeutic drug monitoring), ktoré predstavuje meranie hladiny liečiva ako aj protilátok proti liečivu (ADAb – anti-drug antibodies), je novým prístupom optimalizácie liečby a dosiahnutia najnižšieho rizika straty odpovede. V súčasnosti nie je jasné presná terapeutická hladina, ktorá by zodpovedala klinickej odpovedi. Produkcia ADAb môže viesť k poklesu hladín až neutralizácii liečiva s následnou stratou liečebného účinku. Rovnako môžu ADAb prispieť k infúznym reakciám, tromboembolickým príhodám a sérovej chorobe. Predkladaný článok skúma vývoj TDM pri liečbe IBD. Skúma hlavné tvrdenia o TDM ako aj vývoj ich používania v poslednom období, skúma terapeutické rozmedzie, stratu odpovede a opisuje súčasné trendy v klinickej praxi.

Klíčová slova

biologická terapia, nešpecifické zápalové ochorenia čreva, protilátky proti liečivu, terapeutické monitorovanie liečiva, terapeutické rozmedzie

Celý článek je dostupný po přepnutí na anglickou verzi webové stránky (v pravém horním rohu).

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