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.
Inflamm Bowel Dis. 2019 Aug 29;:
Authors: Casanova MJ, Chaparro M, Mínguez M, Ricart E, Taxonera C, García-López S, Guardiola J, López-San Román A, Iglesias E, Beltrán B, Sicilia B, Vera MI, Hinojosa J, Riestra S, Domènech E, Calvet X, Pérez-Calle JL, Martín-Arranz MD, Aldeguer X, Rivero M, Monfort D, Barrio J, Esteve M, Márquez L, Lorente R, García-Planella E, de Castro L, Bermejo F, Merino O, Rodríguez-Pérez A, Martínez-Montiel P, Van Domselaar M, Alcaín G, Domínguez-Cajal M, Muñoz C, Gomollón F, Fernández-Salazar L, García-Sepulcre MF, Rodríguez-Lago I, Gutiérrez A, Argüelles-Arias F, Rodriguez C, Rodríguez GE, Bujanda L, Llaó J, Varela P, Ramos L, Huguet JM, Almela P, Romero P, Navarro-Llavat M, Abad Á, Ramírez-de la Piscina P, Lucendo AJ, Sesé E, Madrigal RE, Charro M, García-Herola A, Pajares R, Khorrami S, Gisbert JP
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.
PMID: 31504569 [PubMed – as supplied by publisher]