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

Casanova, M.J. ; Chaparro, M. ; Mínguez, M. ; Ricart, E. ; Taxonera, C. ; García-López, S. (Universidad de Zaragoza) ; 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. (Universidad de Zaragoza) ; 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.

Resumen: 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.

Idioma: Inglés

DOI: 10.1093/ibd/izz192

Año: 2020

Publicado en: INFLAMMATORY BOWEL DISEASES 26, 4 (2020), 606-616
ISSN: 1078-0998

Factor impacto JCR: 5.325 (2020)

Categ. JCR: GASTROENTEROLOGY & HEPATOLOGY rank: 30 / 92 = 0.326 (2020) - Q2 - T1

Factor impacto SCIMAGO: 1.931 - Immunology and Allergy (Q1) - Gastroenterology (Q1)

Tipo y forma: Article (PostPrint)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)