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Dig Liver Dis. 2017 Oct;49(10):1086-1091. doi: 10.1016/j.dld.2017.07.010. Epub 2017 Aug 1.

Indicators of suboptimal tumor necrosis factor antagonist therapy in inflammatory bowel disease.

Author information

1
Department of Gastroenterology, Barts Health NHS Trust, London, United Kingdom. Electronic address: James.Lindsay@bartshealth.nhs.uk.
2
IBD Unit, Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Rome, Italy.
3
Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
4
Gastroenterology Practice, Minden, Germany.
5
CHU de Nancy - Hôpital Brabois, Vandoeuvre-lès-Nancy, France.
6
Mount Sinai Hospital, Toronto, Canada.
7
Takeda Development Centre Europe Ltd., London, United Kingdom.

Abstract

BACKGROUND:

Inflammatory bowel disease (IBD) is refractory to treatment in one-half of patients.

AIMS:

To evaluate the occurrence of suboptimal therapy among patients with IBD treated with tumor necrosis factor antagonists (anti-TNFs).

METHODS:

A multinational chart review in Europe and Canada was conducted among IBD patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) who initiated anti-TNF therapy between 2009 and 2013. The primary endpoint was the cumulative incidence of suboptimal therapy during a two-year follow-up period, defined by the presence of the following indicators: dose escalation, discontinuation, switching, non-biologic therapy escalation, or surgery.

RESULTS:

The study included 1195 anti-TNF initiators (538 UC and 657 CD). The majority of patients (64% of UC and 58% of CD) had at least one indicator of suboptimal therapy. The median time to suboptimal therapy indicator was 12.5 and 17.5 months for UC and CD patients, respectively. Among the 111 UC and 174 CD anti-TNF switchers, 51% and 56% had an indicator of suboptimal therapy, respectively. The median time to suboptimal therapy indicator with the second anti-TNF was 14.3 and 13.0 months for UC and CD patients, respectively.

CONCLUSION:

The majority of IBD patients showed suboptimal therapy with current anti-TNFs.

KEYWORDS:

Chart review; Crohn’s disease; Inflammatory bowel disease; Suboptimal therapy; Tumor necrosis factor-alpha (TNF-α) antagonists; Ulcerative colitis

PMID:
28826571
DOI:
10.1016/j.dld.2017.07.010
[Indexed for MEDLINE]
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