Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflam...

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Detalles Bibliográficos
Autores: Casanova, MJ, Chaparro, M, Minguez, M, Ricart, E, Taxonera, C, Garcia-Lopez, S, Guardiola, J, Lopez-San Roman, A, Iglesias, E, Beltran, B, Sicilia, B, Vera, MI, Hinojosa, J, Riestra, S, Domenech, E, Calvet, X, Perez-Calle, JL, Martin-Arranz, MD, Aldeguer, X, Rivero, M, Monfort, D, Barrio, J, Esteve, M, Marquez, L, Lorente, R, Garcia-Planella, E, de Castro, L, Bermejo, F, Merino, O, Rodriguez-Perez, A, Martinez-Montiel, P, Van Domselaar, M, Alcain, G, Dominguez-Cajal, M, Munoz, C, Gomollon, F, Fernandez-Salazar, L, Garcia-Sepulcre, MF, Rodriguez-Lago, I, Gutierrez, A, Arguelles-Arias, F, Rodriguez, C, Rodriguez, GE, Bujanda, L, Llao, J, Varela, P, Ramos, L, Huguet, JM, Almela, P, Romero, P, Navarro-Llavat, M, Abad, A, Ramirez-de la Piscina, P, Lucendo, AJ, Sese, E, Madrigal, RE, Charro, M, Garcia-Herola, A, Pajares, R, Khorrami, S, Gisbert, JP
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repositorio:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p2683
Acceso en línea:https://i3pt.portalinvestigacion.com/publicaciones/2683
Access Level:acceso abierto
Palabra clave:inflammatory bowel disease
Crohn's disease
ulcerative colitis
anti-TNF
switch
Descripción
Sumario:Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response.

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