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Immunological treatment failure of anti-TNF therapy negatively influences treatment persistence of a second anti-TNF in IBD patients. So far it is unknown if this effect is also observed for other monoclonal antibodies. We assessed the influence of immunogenicity to anti-TNFs on treatment persistence of subsequent ustekinumab and vedolizumab therapy. IBD patients with and without immunogenicity to anti-TNFs (undetectable trough levels and antibody titers ≥20 ng/mL) and subsequent ustekinumab (UST) and/or vedolizumab (VDZ) therapy were included in this retrospective, single-center study. The Kaplan-Meier method with the log-rank test and Cox proportional hazards were used as statistical methods. One hundred patients (Crohn's disease: 62, Ulcerative colitis: 31, IBD unclassified: 7) with 127 treatment lines (62 with UST, 65 with VDZ) were included in the analysis. Immunogenicity to previous anti-TNFs did not influence treatment persistence of subsequent ustekinumab and vedolizumab therapy (UST: Log rank: p =.95, Immunogenicity: HR for treatment discontinuation: 0.97 [95% CI 0.31–3.04]; VDZ: p =.65, HR: 0.85 [0.41–1.75]; total cohort [UST and VDZ]: p =.62, HR: 0.86 [0.47–1.57]). Azathioprine co-treatment did not lengthen treatment persistence (UST: Log rank: p =.77, azathioprine: HR: 1.20 [0.34–4.27]; VDZ: p =.92, HR: 0.58 [0.17–1.99]; total cohort: p =.79, HR: 1.10 [0.55–2.20]). In this anti-TNF experienced cohort, patients with ustekinumab remained longer on treatment than patients receiving vedolizumab (Log rank: p =.005, UST: HR: 0.43 [0.23–0.79]). Immunogenicity to anti-TNFs does not influence treatment persistence of subsequent ustekinumab and vedolizumab therapy. [ABSTRACT FROM AUTHOR]

Introductory comments The Bosnia war ended not by peace-keeping, nor by war-making, even if a military intervention was required, but by political engineering: the creation of the Bosnian-Croat Federation (1994) and the General Framework Agreement for Peace in Bosnia and Herzegovina (1995). If pacification and normalisation were the first aims, Bosnia and Herzegovina is now engaged in a complex transition and integration process. But after 8 years of international presence, Bosnia and Herzegovina is still an aid-dependent country, and most aspects of social, political and economic life are now matters of the international protectorate-type intervention. In order to overcome this situation, foreign involvement will remain a prerequisite, but it must absolutely address Bosnian self-government and ownership with an adequate strategy. After a first period of military stabilisation and reconstruction (1995-1997), and a second one of a quasi-protectorate characterised by a strong use of the powers of the High Representative (1997-2000), the main challenge of the third period--now under way--is to enable the transition from an international soft-protectorate to a sustainable and sovereign Bosnian state. The former High Representative Wolfgang Petritsch focused on international power precisely in support of state-building objectives and worked for the Bosnian ownership of a new local institutional environment, which is capable of taking responsibility for the new state. We start this interview with a regional focus, as Wolfgang Petritsch was also Special Envoy of the EU for Kosovo (1998-1999) and later on European Union Chief Negotiator at the Kosovo peace talks in Rambouillet and Paris (1999). [ABSTRACT FROM AUTHOR]