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Controversies in the management of anti-TNF therapy in patients with Crohn's disease: a Delphi consensus.
González-Lama, Yago; Ricart, Elena; Carpio, Daniel; Bastida, Guillermo; Ceballos, Daniel; Ginard, Daniel; Marin-Jimenez, Ignacio; Menchen, Luis; Muñoz, Fernando.
Afiliación
  • González-Lama Y; Gastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
  • Ricart E; Gastroenterology Department, CIBEREHD, Madrid, Spain.
  • Carpio D; Gastroenterology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.
  • Bastida G; Gastroenterology Department, Polytechnic Hospital, Valencia, Spain.
  • Ceballos D; Gastroenterology Department, Hospital Universitario Doctor Negrin, Las Palmas de Gran Canaria, Spain.
  • Ginard D; Gastroenterology Department, Hospital Universitario Son Espases, Palma, Spain.
  • Marin-Jimenez I; Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  • Menchen L; Gastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  • Muñoz F; Gastroenterology Department, Hospital Universitario de Salamanca, Salamanca, Spain jmunozn@gmail.com.
BMJ Open Gastroenterol ; 11(1)2024 Jan 23.
Article en En | MEDLINE | ID: mdl-38267072
ABSTRACT

BACKGROUND:

Despite research, there are still controversial areas in the management of Crohn's disease (CD).

OBJECTIVE:

To establish practical recommendations on using anti-tumour necrosis factor (TNF) drugs in patients with moderate-to-severe CD.

METHODS:

Clinical controversies in the management of CD using anti-TNF therapies were identified. A comprehensive literature review was performed, and a national survey was launched to examine current clinical practices when using anti-TNF therapies. Their results were discussed by expert gastroenterologists within a nominal group meeting, and a set of statements was proposed and tested in a Delphi process.

RESULTS:

Qualitative study. The survey and Delphi process were sent to 244 CD-treating physicians (response rate 58%). A total of 14 statements were generated. All but two achieved agreement. These statements cover (1) use of first-line non-anti-TNF biological therapy; (2) role of HLA-DQA1*05 in daily practice; (3) attitudes in primary non-response and loss of response to anti-TNF therapy due to immunogenicity; (4) use of ustekinumab or vedolizumab if a change in action mechanism is warranted; (5) anti-TNF drug level monitoring; (6) combined therapy with an immunomodulator.

CONCLUSION:

This document sought to pull together the best evidence, experts' opinions, and treating physicians' attitudes when using anti-TNF therapies in patients with CD.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de Crohn Tipo de estudio: Guideline / Prognostic_studies / Qualitative_research Límite: Humans Idioma: En Revista: BMJ Open Gastroenterol Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de Crohn Tipo de estudio: Guideline / Prognostic_studies / Qualitative_research Límite: Humans Idioma: En Revista: BMJ Open Gastroenterol Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Reino Unido