Practical Gastroenterology • October 2010 12 Inflammatory Bowel Disease : a Practical Approach , Series
نویسندگان
چکیده
INTRODUCTION Infliximab (IFX) has transformed the management of inflammatory bowel disease (IBD) [1,2]. It is a peptide and, like all proteins, is immunogenic. This means that the body recognizes the protein as foreign and generates antibodies in an endeavor to neutralize its impact. IFX is also expensive, costing £16456 ($26000) for induction and a year of maintenance therapy in the UK [3]. Drug and administration costs, of course, don’t reflect wider health benefits and economic benefits through reduced hospitalization or surgery and increased productivity at work. We won’t even go there, other than to regret that such pharmacoeconomic studies were not hard wired into the registration trials. It is hardly surprising therefore, that much effort has been spent on trying to predict response, nonresponse and to account for loss of response. IFX is structurally comprised of 75% human and 25% murine protein sequences. The murine component isn’t the cause of immunogenicity (think of antibodies that develop during blood transfusion—fully human proteins are also immunogenic), but generally promotes drug immunogenicity. Adalimumab, for instance, is also immunogenic. Immunogenicity is defined as the potential for an antigen (usually a protein) to induce an immune response after it has been recognized by a pre-existing T-cell or B-cell receptor. It is worth identifying some of the other terminology INFLAMMATORY BOWEL DISEASE: A PRACTICAL APPROACH, SERIES #65
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