doi:10.1093/ibd/izz192engCasanova, M.J.Chaparro, M.Mínguez, M.Ricart, E.Taxonera, C.García-López, S.Guardiola, J.López-San Román, A.Iglesias, E.Beltrán, B.Sicilia, B.Vera, M.I.Hinojosa, J.Riestra, S.Domènech, E.Calvet, X.Pérez-Calle, J.L.Martín-Arranz, M.D.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, M.F.Rodríguez-Lago, I.Gutiérrez, A.Argüelles-Arias, F.Rodriguez, C.Rodríguez, G.E.Bujanda, L.Llaó, J.Varela, P.Ramos, L.Huguet, J.M.Almela, P.Romero, P.Navarro-Llavat, M.Abad, Á.Ramírez-De La Piscina, P.Lucendo, A.J.Sesé, E.Madrigal, R.E.Charro, M.García-Herola, A.Pajares, R.Khorrami, S.Gisbert, J.P.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 RegistryART-2020-117227Background: 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.2020http://zaguan.unizar.es/record/9504010.1093/ibd/izz192http://zaguan.unizar.es/record/95040oai:zaguan.unizar.es:95040INFLAMMATORY BOWEL DISEASES 26, 4 (2020), 606-616All rights reservedhttp://www.europeana.eu/rights/rr-f/info:eu-repo/semantics/openAccess