Effectiveness of anti-TNFα drugs in patients with Crohn's disease who do not achieve remission with their first anti-TNFα agent

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• 作者：Marí ; a del Carmen R-Grau^a ; ^{mc.r.grau@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Marí ; a Chaparro^a ; Francisco Mesonero^b ; Manuel Barreiro-de Acosta^c ; Luisa Castro^d ; Manuel Castro^e ; Eugeni Domè ; nech^f ; Noemí ; Mancenido^g ; Jos&eacute ; Lá ; zaro P&eacute ; rez-Calle^h ; Carlos Taxoneraⁱ ; Jesú ; s Barrio^j ; Ruth De Francisco^k ; Estela Ferná ; ndez-Salgado^l ; Lara Luzó ; n^m ; Olga Merinoⁿ ; Lorena Oltra^o ; Cristina Saro^p ; Fernando Bermejo^q ; Valle Garcí ; a-Sá ; nchez^r ; Daniel Ginard^s ; Ana Guti&eacute ; rrez^t ; Isabel Vera^u ; Rosario Antó ; n^v ; Yolanda Ber^w ; Xavier Calvet^x ; Javier P. Gisbert^a
• 关键词：Crohn's disease ; Primary failure ; Primary non-responder
• 刊名：Digestive and Liver Disease
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：48
• 期：6
• 页码：613-619
• 全文大小：626 K

文摘

Anti-TNF treatment is effective for Crohn's disease (CD); however, some patients did not achieve remission with these drugs.

Aims

To evaluate the short-term effectiveness of a second anti-TNF in CD patients who did not achieve remission with the first one and to assess its durability.

Methods

Patients who did not achieve remission with their first anti-TNF were included. The short-term response of the second anti-TNF was assessed, the long-term response was evaluated in patients who achieved remission (Kaplan–Meier). Cox-regression was performed to identify predictors of loss of efficacy.

Results

In all, 118 CD patients received a second anti-TNF after primary failure of the first. The first anti-TNF was discontinued because of non-response in 54% of patients and partial response in 46%. Fifty-one percent of patients achieved remission in the short-term. The probability of remission was lower in patients for whom the drug indication was perianal disease (OR = 0.3, 95% CI = 0.1–0.7, P = 0.005). The dose was increased in 33% of patients, and 37% achieved/regained remission. The probability of maintaining remission was 76%, 68% and 64% at 12, 18 and 24 months, respectively.

Conclusions

Approximately half of the patients achieved remission with a second anti-TNF after primary failure of the first, this strategy was less effective in patients with perianal disease.