Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis

Loss of response to antitumor necrosis factor (anti-TNF) therapies in inflammatory bowel disease occurs in a high proportion of patients. Our aim was to evaluate the loss of response to anti-TNF therapy, considered as the need for dose intensification (DI), DI effectiveness and the possible variable...

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Detalles Bibliográficos
Autores: Guberna, Laura, Nyssen, Olga P., Chaparro Sánchez, María, Pérez Gisbert, Francisco Javier
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universidad Autónoma de Madrid
Repositorio:Biblos-e Archivo. Repositorio Institucional de la UAM
Idioma:inglés
OAI Identifier:oai:repositorio.uam.es:10486/698079
Acceso en línea:http://hdl.handle.net/10486/698079
https://dx.doi.org/10.3390/jcm10102132
Access Level:acceso abierto
Palabra clave:Anti-TNF-α
Crohn’s disease
Dose intensification
Inflammatory bowel disease
Loss of response
Ulcerative colitis
Medicina
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spelling Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysisGuberna, LauraNyssen, Olga P.Chaparro Sánchez, MaríaPérez Gisbert, Francisco JavierAnti-TNF-αCrohn’s diseaseDose intensificationInflammatory bowel diseaseLoss of responseUlcerative colitisMedicinaLoss of response to antitumor necrosis factor (anti-TNF) therapies in inflammatory bowel disease occurs in a high proportion of patients. Our aim was to evaluate the loss of response to anti-TNF therapy, considered as the need for dose intensification (DI), DI effectiveness and the possible variables influencing its requirements. Bibliographical searches were performed. Selection: prospective and retrospective studies assessing DI in Crohn’s disease and ulcerative colitis patients treated for at least 12 weeks with an anti-TNF drug. Exclusion criteria: studies using anti-TNF as a prophylaxis for the postoperative recurrence in Crohn’s disease or those where DI was based on therapeutic drug monitoring. Data synthesis: effectiveness by intention-to-treat (random effects model). Data were stratified by medical condition (ulcerative colitis vs. Crohn’s disease), anti-TNF drug and follow-up. Results: One hundred and seventy-three studies (33,241 patients) were included. Overall rate of the DI requirement after 12 months was 28% (95% CI 24–32, I2 = 96%, 41 studies) in naïve patients and 39% (95% CI 31–47, I2 = 86%, 18 studies) in non-naïve patients. The DI requirement rate was higher both in those with prior anti-TNF exposure (p = 0.01) and with ulcerative colitis (p = 0.02). The DI requirement rate in naïve patients after 36 months was 35% (95% CI 28–43%; I2 = 98%; 18 studies). The overall short-term response and remission rates of empirical DI in naïve patients were 63% (95% CI 48–78%; I2 = 99%; 32 studies) and 48% (95% CI: 39–58%; I2 = 92%; 25 studies), respectively. The loss of response to anti-TNF agents—and, consequently, DI—occurred frequently in inflammatory bowel disease (approximately in one-fourth at one year and in one-third at 3 years). Empirical DI was a relatively effective therapeutic option.MDPI, Basel, SwitzerlandDepartamento de MedicinaFacultad de MedicinaInstituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP)20212021-05-01research articlehttp://purl.org/coar/resource_type/c_2df8fbb1VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10486/698079https://dx.doi.org/10.3390/jcm10102132reponame:Biblos-e Archivo. Repositorio Institucional de la UAMinstname:Universidad Autónoma de MadridInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:repositorio.uam.es:10486/6980792026-06-23T12:46:27Z
dc.title.none.fl_str_mv Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis
title Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis
spellingShingle Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis
Guberna, Laura
Anti-TNF-α
Crohn’s disease
Dose intensification
Inflammatory bowel disease
Loss of response
Ulcerative colitis
Medicina
title_short Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis
title_full Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis
title_fullStr Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis
title_full_unstemmed Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis
title_sort Frequency and effectiveness of empirical anti-tnf dose intensification in inflammatory bowel disease: Systematic review with meta-analysis
dc.creator.none.fl_str_mv Guberna, Laura
Nyssen, Olga P.
Chaparro Sánchez, María
Pérez Gisbert, Francisco Javier
author Guberna, Laura
author_facet Guberna, Laura
Nyssen, Olga P.
Chaparro Sánchez, María
Pérez Gisbert, Francisco Javier
author_role author
author2 Nyssen, Olga P.
Chaparro Sánchez, María
Pérez Gisbert, Francisco Javier
author2_role author
author
author
dc.contributor.none.fl_str_mv Departamento de Medicina
Facultad de Medicina
Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP)
dc.subject.none.fl_str_mv Anti-TNF-α
Crohn’s disease
Dose intensification
Inflammatory bowel disease
Loss of response
Ulcerative colitis
Medicina
topic Anti-TNF-α
Crohn’s disease
Dose intensification
Inflammatory bowel disease
Loss of response
Ulcerative colitis
Medicina
description Loss of response to antitumor necrosis factor (anti-TNF) therapies in inflammatory bowel disease occurs in a high proportion of patients. Our aim was to evaluate the loss of response to anti-TNF therapy, considered as the need for dose intensification (DI), DI effectiveness and the possible variables influencing its requirements. Bibliographical searches were performed. Selection: prospective and retrospective studies assessing DI in Crohn’s disease and ulcerative colitis patients treated for at least 12 weeks with an anti-TNF drug. Exclusion criteria: studies using anti-TNF as a prophylaxis for the postoperative recurrence in Crohn’s disease or those where DI was based on therapeutic drug monitoring. Data synthesis: effectiveness by intention-to-treat (random effects model). Data were stratified by medical condition (ulcerative colitis vs. Crohn’s disease), anti-TNF drug and follow-up. Results: One hundred and seventy-three studies (33,241 patients) were included. Overall rate of the DI requirement after 12 months was 28% (95% CI 24–32, I2 = 96%, 41 studies) in naïve patients and 39% (95% CI 31–47, I2 = 86%, 18 studies) in non-naïve patients. The DI requirement rate was higher both in those with prior anti-TNF exposure (p = 0.01) and with ulcerative colitis (p = 0.02). The DI requirement rate in naïve patients after 36 months was 35% (95% CI 28–43%; I2 = 98%; 18 studies). The overall short-term response and remission rates of empirical DI in naïve patients were 63% (95% CI 48–78%; I2 = 99%; 32 studies) and 48% (95% CI: 39–58%; I2 = 92%; 25 studies), respectively. The loss of response to anti-TNF agents—and, consequently, DI—occurred frequently in inflammatory bowel disease (approximately in one-fourth at one year and in one-third at 3 years). Empirical DI was a relatively effective therapeutic option.
publishDate 2021
dc.date.none.fl_str_mv 2021
2021-05-01
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/10486/698079
https://dx.doi.org/10.3390/jcm10102132
url http://hdl.handle.net/10486/698079
https://dx.doi.org/10.3390/jcm10102132
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv MDPI, Basel, Switzerland
publisher.none.fl_str_mv MDPI, Basel, Switzerland
dc.source.none.fl_str_mv reponame:Biblos-e Archivo. Repositorio Institucional de la UAM
instname:Universidad Autónoma de Madrid
instname_str Universidad Autónoma de Madrid
reponame_str Biblos-e Archivo. Repositorio Institucional de la UAM
collection Biblos-e Archivo. Repositorio Institucional de la UAM
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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