1. 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
- Author
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Laura Ramos, Patricia Ramirez de la Piscina, Carlos Taxonera, Luisa de Castro, Belén Beltrán, Fernando Bermejo, Rosa Eva Madrigal, E Sesé, Fernando Gomollón, Alfredo J. Lucendo, Jesús Barrio, Xavier Calvet, Joaquín Hinojosa, Cristina Rodríguez, Gloria Esther Rodriguez, Carmen Muñoz, Ana Gutiérrez, Mara Charro, Eugeni Domènech, David Monfort, Esther Garcia-Planella, M F García-Sepulcre, José María Huguet, María Chaparro, Javier P. Gisbert, R. Pajares, José Lázaro Pérez-Calle, Montserrat Rivero, Jordi Guardiola, Luis Fernández-Salazar, Federico Argüelles-Arias, Xavier Aldeguer, Agueda Abad, Jordina Llaó, Guillermo Alcain, Pedro Almela, Sabino Riestra, Olga Merino, M Navarro-Llavat, Luis Bujanda, Manuel Domínguez-Cajal, Maria Esteve, Sam Khorrami, María Dolores Martín-Arranz, Lucía Márquez, Antonio Roman, María Isabel Vera, Rufo Lorente, Antonio García-Herola, Beatriz Sicilia, A Rodríguez-Pérez, Pilar Varela, Santiago García-López, Pilar Martínez-Montiel, Miguel Minguez, Manuel Van Domselaar, María José Casanova, Patricia Romero, Iago Rodríguez-Lago, Elena Ricart, and Eva Iglesias
- Subjects
Crohn’s disease ,Male ,Kaplan-Meier Estimate ,Inflammatory bowel disease ,Crohn Disease ,Immunology and Allergy ,Prospective Studies ,Registries ,Child ,anti-TNF ,Crohn's disease ,Incidence (epidemiology) ,Remission Induction ,Hazard ratio ,Gastroenterology ,Middle Aged ,Necrosi ,ulcerative colitis ,Ulcerative colitis ,switch ,Malalties inflamatòries intestinals ,Child, Preschool ,Female ,inflammatory bowel disease ,Adult ,medicine.medical_specialty ,Adolescent ,Combination therapy ,Inflammatory bowel diseases ,Crohn’s disease, anti-TNF, inflammatory bowel disease, switch, ulcerative colitis ,Young Adult ,Necrosis ,Internal medicine ,medicine ,Humans ,Adverse effect ,Aged ,business.industry ,Adalimumab ,medicine.disease ,Infliximab ,Confidence interval ,Logistic Models ,Spain ,Multivariate Analysis ,Colitis, Ulcerative ,Tumor Necrosis Factor Inhibitors ,business - Abstract
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.
- Published
- 2020