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Dig Liver Dis. 2016 Jun;48(6):613-9. doi: 10.1016/j.dld.2016.02.012. Epub 2016 Mar 2.

Effectiveness of anti-TNFα drugs in patients with Crohn's disease who do not achieve remission with their first anti-TNFα agent.

Author information

1
Department of Gastroenterology, La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. Electronic address: mc.r.grau@gmail.com.
2
Department of Gastroenterology, La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
3
Department of Gastroenterology, Ramón y Cajal, Madrid, Spain.
4
Department of Gastroenterology, Clínico de Santiago, Santiago de Compostela, Spain.
5
Department of Gastroenterology, Virgen Macarena, Sevilla, Spain.
6
Department of Gastroenterology, Valme, CIBEREHD, Sevilla, Spain.
7
Department of Gastroenterology, Germans Trias i Pujol, CIBEREHD, Badalona, Spain.
8
Department of Gastroenterology, Infanta Sofía, Madrid, Spain.
9
Department of Gastroenterology, Fundación Alcorcón, Madrid, Spain.
10
Department of Gastroenterology, Clínico San Carlos, Madrid, Spain.
11
Department of Gastroenterology, Río Hortega, Valladolid, Spain.
12
Department of Gastroenterology, Central de Asturias, Oviedo, Spain.
13
Department of Gastroenterology, Complejo Hospitalario Universitario, Pontevedra, Spain.
14
Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
15
Department of Gastroenterology, Cruces, Vizcaya, Spain.
16
Department of Gastroenterology, Manises, Valencia, Spain.
17
Department of Gastroenterology, Cabueñes, Gijón, Spain.
18
Department of Gastroenterology, Fuenlabrada, Madrid, Spain.
19
Department of Gastroenterology, Reina Sofía, Maimónides Institute of Biomedical Research of Córdoba, Córdoba, Spain.
20
Department of Gastroenterology, Son Espases, Mallorca, Spain.
21
Department of Gastroenterology, General de Alicante, Alicante, Spain.
22
Department of Gastroenterology, Puerta de Hierro, Madrid, Spain.
23
Department of Gastroenterology, Clínico de Valencia, Valencia, Spain.
24
Department of Gastroenterology, Clínico Universitario Lozano Blesa, CIBEREHD, Zaragoza, Spain.
25
Department of Gastroenterology, Parc Tauli, CIBEREHD, Sabadell, Spain.

Abstract

BACKGROUND:

Anti-TNF treatment is effective for Crohn's disease (CD); however, some patients did not achieve remission with these drugs.

AIMS:

To evaluate the short-term effectiveness of a second anti-TNF in CD patients who did not achieve remission with the first one and to assess its durability.

METHODS:

Patients who did not achieve remission with their first anti-TNF were included. The short-term response of the second anti-TNF was assessed, the long-term response was evaluated in patients who achieved remission (Kaplan-Meier). Cox-regression was performed to identify predictors of loss of efficacy.

RESULTS:

In all, 118 CD patients received a second anti-TNF after primary failure of the first. The first anti-TNF was discontinued because of non-response in 54% of patients and partial response in 46%. Fifty-one percent of patients achieved remission in the short-term. The probability of remission was lower in patients for whom the drug indication was perianal disease (OR=0.3, 95% CI=0.1-0.7, P=0.005). The dose was increased in 33% of patients, and 37% achieved/regained remission. The probability of maintaining remission was 76%, 68% and 64% at 12, 18 and 24 months, respectively.

CONCLUSIONS:

Approximately half of the patients achieved remission with a second anti-TNF after primary failure of the first, this strategy was less effective in patients with perianal disease.

KEYWORDS:

Crohn's disease; Primary failure; Primary non-responder

PMID:
26992847
DOI:
10.1016/j.dld.2016.02.012
[Indexed for MEDLINE]

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